Preamble

The House met at half-past Nine o'clock

PRAYERS

[MADAM SPEAKER in the Chair]

Petition

National Health Service (Greenwich)

Mr. John Austin-Walker: Madam Speaker, I have a petition in the prescribed form, supported by 16,000 signatures on further petitions, which expresses the widespread concern in Greenwich and Woolwich regarding the impact of the Government's reforms of the national health service and of the reneging on the pledges given when the Greenwich health care trust was established. A pledge was given to develop on the Brook hospital site an elective resource centre, an integral part of which was to be the regional specialty cardio-thoracic service.
The petition reads:
Wherefore your Petitioners pray that your Honourable House will appeal to the Secretary of State for Health to intervene to stop possible closures of the Brook, Memorial and Greenwich district hospitals and to establish a public inquiry into the state of the national health service in the Greenwich health district.
And your Petitioners, as in duty bound, will ever pray, etc,

To lie upon the Table.

Orders of the Day — Chiropractors Bill

Order for Second Reading read.

Mr. David Lidington: I beg to move, That the Bill be now read a Second time.
The central purpose of my Bill is to establish a statutory registration scheme for chiropractors, to regulate the profession and to require all persons calling themselves chiropractors to register with a new statutory council. That new statutory body, the General Chiropractic Council, will have the duty to regulate, promote and develop the profession of chiropractic and to lay down standards of professional conduct and education.
My Bill also provides for the establishment of four statutory committees to advise the general council on matters relating to chiropractic education and training and to ensure that any complaint or allegation made about a registered practitioner's fitness to practise chiropractic is properly investigated and effectively dealt with.
In the current week, as in every other week in the present year, more than 75,000 patients in the United Kingdom will have had chiropractic treatment. Since agreeing, at the urging of the profession, to introduce the Bill, I have been amazed and delighted by the number of friends, members of my family and hon. Members on both sides of the Chamber who have approached me and told me of the treatment that they have received from a chiropractor. No one has had anything but praise for the efficient and effective care that they have received. Chiropractic is already, after osteopathy, the second most widely used complementary therapy in the country.
The statutory scheme set out in the Bill reflects closely that of the Osteopaths Act 1993. As the House will know, that Act was introduced as a private Member's Bill by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). He has written to me to explain that, due to constituency engagements, he cannot be present today, but I was delighted that he was willing to act as one of my sponsors and I am grateful to him for blazing a trail which I am now able to follow.
Chiropractic comes in the range of therapies and treatments referred to as alternative and complementary medicine. It is a bio-mechanical therapy, based on the premise that the spine carries and protects a large part of the body's central nervous system and consequently has a key role in ensuring that the body functions effectively. If the spine becomes too rigid, or too mobile, the nervous system may be affected and such a condition can certainly cause pain, not merely in the back, but in other parts of the body as well. Chiropractic is a means of diagnosing the presence of such a condition and of making various adjustments or manipulations of the vertebrae to correct: it.
One or two of my hon. Friends may conceivably ask why, if things are working so well at the moment, the chiropractic profession is seeking statutory regulation. The answer is straightforward. At present there is nothing to prevent me, or you, Mr. Deputy Speaker, or anyone else in the Chamber or elsewhere, from simply fixing a brass plate with the title "chiropractor" to our gatepost and immediately offering to treat anyone who was unwise or


unfortunate enough to come through the door and take the risk. No minimum standards are required; no training is necessary.
From the little that I have said already about what happens during chiropractic treatment, it must be obvious that there is potential, in untrained hands, to do a great deal of harm. The manipulation of necks and backs could be lethal without the proper degree of skill. Even relatively minor adjustments to limbs, if attempted in ignorance, could result in severe damage.
Equally important, serious underlying conditions—for example, cancer—can present symptoms very similar to back pain and an untrained manipulator might, therefore, persist in treatment that has no prospect of helping the patient. He or she ought to advise the patient to go immediately to his doctor. Regrettably, cases have been reported where what appeared to be a bad back masked much more serious illness, so it is not just a matter of chiropractors treating bad backs.
Fundamental to a chiropractor's skill is the ability to make what is known as differential diagnoses—in layman's language, the ability to diagnose conditions that will not respond to the chiropractor's skills and conditions that should be referred immediately for orthodox medical treatment.
A good, responsible chiropractor will take a careful case history and carry out a thorough physical examination of each patient before commencing treatment. Some chiropractors may also make use of other diagnostic tests such as X-rays or blood and urine analysis, but by far the most important diagnostic tools for all chiropractors are the practitioner's hands.
Virtually every chiropractor treatment is given to relieve joint, bone, muscle or tendon pain in one of the many forms in which it can occur. Almost half of all cases concern problems with the lower back and pelvis, including cases where the source of trouble is in those parts of the body but the pain is felt by the patient elsewhere—in the groin, thighs, legs or feet. About a quarter of treatments are for neck problems, which either cause pain in the back or referred pain in the shoulders, chest, arms or hands. About one in 10 treatments is for headaches and migraines, and chiropractors will also give treatment for thoracic pain and for local injuries to limbs not directly affected by the spine. Those are general figures, which do not reflect the fact that many patients arrive at their chiropractor with a combination of head, neck, thoracic and lumbar pain and perhaps co-existing organic problems.
I have been fortunate, in the past few weeks, since agreeing to take on the Bill, to have been given permission by some chiropractic patients to observe their treatment taking place. I have been struck by the way in which chiropractic not only can be used effectively to treat backs and joints, but can play an important role in helping people suffering from chronic organic disease to remain mobile, and so retain their much-prized independence longer than might otherwise be the case.
Chiropractic is, therefore, a therapy that deals with a large number of people who experience considerable pain and discomfort. The therapeutic techniques that are used could be dangerous in unskilled hands and there is a need to ensure that other serious conditions are not overlooked in the analysis of the patient.
While the profession remained small, it was difficult for an untrained or incompetent practitioner to pass unnoticed. However, as more patients have chosen to have chiropractic treatment, the number of practitioners in the country has grown rapidly. Today there are more than 900 chiropractors in all parts of the United Kingdom and, as the profession expands rapidly, the likelihood increases of someone continuing in incompetent practice for longer, or even of an untrained person setting up in practice.
Virtually every practising chiropractor in the kingdom is already a member of a voluntary registration scheme, but the profession recognises that a voluntary system of control is now inadequate. A voluntary system cannot provide members of the public with the level of assurance that many people would wish to have about their practitioner. If, for example, an incompetent practitioner were struck off a voluntary register, he or she would remain free under the present law to continue in practice, and to continue describing himself or herself, perfectly legally, as a chiropractor, and a patient who was injured in such circumstances by an incompetent practitioner would have no opportunity for redress apart from a civil action through the courts, with all the expense and delay that that would entail.
My Bill would replace the present system of voluntary registration by a single statutory council, to be known as the General Chiropractic Council. As I have mentioned, the statutory organisation will have the duty to develop, promote and regulate the profession of chiropractic and to lay down standards of professional conduct and standards for the education and training of practitioners.
As mentioned previously, the Osteopaths Act 1993 has provided a pattern for other professional groups to follow. My Bill, like that Act, has its antecedents in a report of an expert working party set up under the aegis of the King's Fund to bring forward recommendations for the statutory regulation of the profession. It is a tribute to the chiropractic profession that it was able to secure the agreement of the King's Fund to set up a working party so shortly after the working party on osteopathy had reported, and while the recommendations of that report were still being considered by Parliament in the form of the Bill presented by my hon. Friend the Member for Cambridgeshire, North-East.
The working party on the chiropractic profession included representatives in the chiropractic profession and the medical profession, as well as members reflecting the interests of patients and of the general public. I know that the chiropractic profession would wish me to take the opportunity to express, on its behalf, its thanks to the King's Fund and to the members of its working party, especially the chairman, the right hon. Sir Thomas Bingham.
Like other similar statutory schemes, the general council's activities would be overseen by the Privy Council. My Bill therefore confers powers, known as default powers, on the Privy Council, which it would be able to exercise in the extremely unlikely event that the general council failed to carry out its statutory responsibilities or functions properly. Those powers will enable tile Privy Council to direct the general council as to the proper exercise of its functions under the Act and, if necessary, as a last resort, the Privy Council could step in, take over the responsibilities of the general council and do anything that the general council would have the power to do.
I ought to emphasise that there is no known case of the Privy Council having to exercise its default powers in respect of other similar statutory schemes. However, as a result of the remote possibility that that might happen, the Bill has public expenditure implications. Such public expenditure would be necessary only to cover the costs incurred by the Privy Council if those default powers were triggered. In all other respects, the regulatory system that I propose would be self-financed through the annual registration fees paid by chiropractors.
As with other statutory schemes of that type, the Bill will provide a broad framework in which the statutory scheme will operate. The more detailed, day-to-day aspects of the scheme will be set down in rules made by the general council. Another duty of the Privy Council will be to approve those rules, which will cover the entire range of the general council's responsibilities, as well as the procedural rules of the four statutory committees. Those rules would take the form of statutory instruments, which, in a handful of specific cases, would also be subject to the negative parliamentary procedures.
Arising from the rule-making powers of the general council, it is necessary for me to refer to the position regarding monopolies and competition law, especially in the light of the recent Monopolies and Mergers Commission report on private medical services. If my Bill is enacted, the same position will exist for chiropractors as now exists for private medical services. My Bill contains a provision in clause 33 to ensure that the establishment of a statutory organisation with the power to make rules and give guidance to the profession will not prevent the application of fair trading and competition law.
The Secretary of State for Trade and Industry will be able to require the general council, as he has recently required the British Medical Association, to make any changes that he considers necessary to rules or guidance if such rules or guidance are found in a Monopolies and Mergers Commission report to be against the public interest. That does not change the present position. Voluntary associations of chiropractors are already subject to the monopoly provisions of the Fair Trading Act 1973 and the provisions relating to anti-competitive practices in the Competition Act 1980.
Let me say a few words about the general council. It will comprise 20 members made up of three groups. The largest group will be 10 chiropractors elected by fully registered practitioners to represent the profession. Then there will be four educational members, three of whom will be appointed by the education committee of the general council to advise on matters relating to chiropractic education and training, while the fourth education member will be appointed by the Secretary of State to advise on professional education matters.
The last group on the general council will be six lay members. They will not be registered chiropractors and will be appointed by the Privy Council to represent the interests of patients, consumers and the general public. There will be a requirement for one of the lay members to be a registered medical practitioner.
The groups mirror those set out in the Osteopaths Act 1993 and will provide the general council with a broad breadth of experience, thereby ensuring that the profession has a firm and balanced basis from which to develop in the future.

Lady Olga Maitland: I thank my hon. Friend for giving way in a most important speech on a Bill which is enormously welcome. Could he possibly tell the House what the costs are likely to be for establishing the general council and where that money will come from?

Mr. Lidington: My hon. Friend makes an important point. At this stage, it is impossible to predict exactly what the costs will be, but, as I said, they will be borne by the chiropractic profession. The various voluntary associations—there are three in this country—already charge their members an annual subscription. In the case of the largest association, the British Chiropractic Association, the fee is just under £1,000 a year. Although one can never be certain about these things, the charge will be a matter for the profession and the general council when it is established. The anticipated subscription would be the BCA level or more once the statutory scheme comes into being.
I must emphasise that my Bill is not about imposing a statutory scheme on chiropractors. It is about—the intervention of my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) gives way to this point—enabling the profession to chart its own destiny within a framework laid down in statute.
In the beginning, there will be neither the election machinery nor the electorate of registered practitioners to elect the first group of chiropractic members of the general council and there will need to be some transitional arrangements. The first general council therefore will be appointed in its entirety by the Privy Council, and the first elected chiropractic members of the general council will take up office following elections which will be held three years after the opening of the register.
As I said, there are a number of bodies administering a voluntary registration scheme among British practitioners. Chiropractic in the United Kingdom has developed along three distinctive paths. Each group of practitioners has its own system of voluntary registration, and a fourth separate organisation is based in Scotland for Scottish chiropractors. These groups vary in size and strength.
Not unreasonably, the smaller groups have at times been concerned that they might not be able to retain their individuality in the future. It is therefore a tribute to the profession, and especially to the chiropractic registration steering group, which was founded in 1991 to provide the focus for pursuing the objective of statutory regulation, that the whole profession is working to achieve statutory regulation for all parts of the profession. There is co-operation among the three different strands of British chiropractic to achieve that purpose.
When I have met chiropractors from different branches of the profession and visited their schools, I have been impressed by the diversity among the different groups and the strengths which each of them brings to the chiropractic profession. I emphasise that the general council's statutory duties to develop, regulate and promote the chiropractic profession extend equally to all parts of the profession.
Before I move on to the nuts and bolts of the Bill, I draw the attention of hon. Members to one or two apparently minor yet significant details. First, the Bill includes a number of amendments to the Osteopaths Act 1993. They are what could be described as fine-tuning amendments to enable the osteopath registration scheme to run more smoothly. Secondly, my Bill contains a provision to amend the Video Recordings Act 1984. Given the public


controversy about the whole topic of video recordings at present, I state firmly that my Bill does not seek to amend the Video Recordings Act or the rules that it embodies. There is no question of opening any loophole that could be exploited by unscrupulous people.
The Video Recordings Act carries an exemption with regard to video recordings for training in or carrying on any medical or related occupation. Clause 39 of the Bill would extend the exemption to registered chiropractors and registered osteopaths whose training videos would then be treated like training videos for members of the orthodox medical profession, who are already granted such an exemption.
I turn to the code of conduct. The principal statutory duty that will be conferred on the general council by my Bill will be a requirement to prepare and publish a code of professional conduct and a standard of proficiency. The code of conduct will set out the standards of conduct and practice expected of a registered chiropractor and will give advice on the practice of chiropractic. When the general council draws up the code, it will have a statutory duty to consult representatives of the profession. Failure by a practitioner to comply with the code will not in itself be a disciplinary offence but will stand to be taken into account in any disciplinary proceedings that might subsequently be initiated against a chiropractor under the fitness-to-practise provisions of the Bill.

Lady Olga Maitland: I thank my hon. Friend for being patient and for allowing me to intervene again on the important point about disciplinary measures. Can he tell the House what sort of offence would require disciplinary measures? For example, if a chiropractor commits a driving offence, is that considered sufficiently serious, or would the general council be looking at offences such as drink offences and fraud?

Mr. Lidington: I intend to deal later in more detail with the disciplinary and investigative procedures. The key principle is that an action or an offence would be relevant if it were important to a chiropractor's fitness to practise. An error or misdeed on his part which is completely irrelevant to his fitness to practise would be considered by the investigating committee and probably dismissed by that committee as something which should not be considered further under the disciplinary procedure.
I alluded to the standard of proficiency. As the name implies, this will be a benchmark for what the general council considers to be safe and competent practice. The standard of proficiency lies at the heart of the statutory scheme. It will be used to judge whether a qualification should be recognised or remain recognised for the purposes of entitling a practitioner to be registered under the Act. It will serve as a means to enable a practitioner to know whether his or her competencies are up to scratch. It will determine whether an allegation of incompetence or malpractice is well founded. It will be used to highlight possible subjects for post-registration training courses. Under the transitional arrangements that will follow the opening of the register—nicknamed the transitional arrangements—the standard of proficiency will be used to decide whether an applicant should be granted registration on the basis of his or her previous practice. The general

council will be obliged to keep the standard of proficiency under review and to update it as and when it considers necessary.
In updating the standard, the general council will be required to publish both the statement setting out the new standard and the accompanying statement explaining how the new standard differs from its predecessor. The power to review and revise the standard of proficiency will give the general council the means by which to develop the profession and to improve the skills and competency of practitioners. To avoid abrupt changes, especially for chiropractic schools and other training institutions, which need time to make any adjustment in their courses, a period of one year will separate the publication of any revised standard from the time when it comes into force.
The statutory registrar will have the duty to establish and maintain the official register of people who are entitled to practise chiropractic in the United Kingdom. He or she will be appointed by the general council. To assist the registrar, the general council will appoint experienced professional, legal and medical assessors. Appeals by practitioners against a decision of the registrar to refuse, for example, to register them or to register them in a particular category will lie first with the general council and thereafter either with the Privy Council or High Court in England and Wales, or the equivalent in Scotland and Northern Ireland.

Lady Olga Maitland: I thank my hon. Friend for again allowing me to intervene as I want to raise an important matter. Will a chiropractor who is registered in this country be able to practise in the European Community? By the same token, will a chiropractor who is registered in another country in the European Community be able to practise in the UK?

Mr. Lidington: The position is slightly complicated. Chiropractic is conducted by non-medically qualified practitioners in a few other EC member states, although it is thought that liberalising forces are at work there. The regulation of the chiropractic profession in the United Kingdom will not automatically give non-medically qualified chiropractors in Britain the right to work in other member states in which the practice of chiropractic is legally restricted to those who are medically qualified. In France, for example, one must be a qualified medical practitioner before one is allowed to work as a chiropractor. The automatic reciprocity that exists in some other professions does not apply.
It will be up to the general council, under its rule-making powers, to decide how it keeps the register—whether it is bound in a great leather ledger, with names filled in by quill pen, or whether the information is kept on a sparkling new video computer database. The general council will also be able to make decisions on such matters as the fee to be charged for entry in the register and additional information that it wants to appear in it. Such information could include other qualifications held by a registered chiropractor or the additional addresses of a registered chiropractor if he operates from more than one premise.
The Bill lays down certain details on all practitioners that must by law appear on the register. Some of those details are obvious. They include the name of the practitioner, the level of registration that he or she holds—full, conditional, or provisional—and the registered


address, which will be the location of the chiropractor's principal practice. The registrar will also be required to place on the register any period during which the chiropractor's registration has been suspended and to show under which provision of the legislation the suspension has been made. While suspended, a chiropractor will cease to be registered and will therefore not be permitted to continue in practice.
The register will be available for public inspection at all reasonable times to provide members of the public with a means of checking the bona fides of people calling themselves chiropractors.
In addition, the Bill makes provision for the general council to publish annually a list of names and to register addresses of everyone who, at the time of publication, is a registered chiropractor. One might call that list the published register, or the popular version. It will be for the general council to determine whether the list should also include additional information derived from the register. A woman chiropractor who wishes to practise under both her maiden name and her married name may have that fact reflected in the published version of the register. Under the Bill, it would be possible for the published copy to be sold or given to members of the public, and supplied to public libraries, GPs' surgeries and other health professionals.
The key difference between the published version of the register and the central statutory register is that the published register will not include details of any practitioner who is currently suspended from practice. That is because the practitioner should not be exposed to a form of double jeopardy. Registration may be suspended for a number of reasons. An investigation may be carried out into an allegation against a practitioner and an interim suspension may be imposed to protect members of the public while that investigation takes place. But the outcome of that investigation might clear the chiropractor's name, in which case the entry made against his or her name in the master register will immediately be removed.
The published register will be published only once each year. It would therefore be possible, if my Bill did not provide otherwise, for a reference to the suspension of a chiropractor whose name had been cleared to appear in the out-of-date published register. The inaccurate public version might still be in circulation when the next edition was published and distributed. There would be a risk, therefore, of an unwarranted doubt being cast on the name of a practitioner. The safeguard of holding back suspended practitioners' names from the published version of the register is included in the Bill; such safeguards are a feature of other similar statutory schemes.

Lady Olga Maitland: When will the register come into force and what will happen to those chiropractors who are registered with the three voluntary organisations that exist? How will they make the transition from the voluntary organisations to the official register, and is there any danger of confusion between the two?

Mr. Lidington: I know that my hon. Friend follows closely such matters as the system of registration. I ask her to remain patient for a little while because I will deal with that subject soon.
The implementation of the register will depend in part, of course, on the progress made on the Bill, but I hope that the general council will be established within 18 months or two years of the Bill's receiving Royal Assent. The

statutory register will probably open 18 months or two years after the general council has been set up. That is the rough timetable.
My hon. Friend's intervention was apposite because I was about to deal with the subject of registration. The Bill will require that a person must be registered with the general council to call himself a chiropractor, and to practise as such.
That requirement will be backed up by the creation of a new criminal offence to be introduced once the initial transitional period had elapsed. That would provide that a person who was not a registered chiropractor but who, after enactment, described himself or herself as a chiropractor either expressly or by implication would be liable on summary conviction to a fine not exceeding level 5 of the standard scale—that is currently £5,000.
My Bill provides for three different categories of registration—full, conditional and provisional. I should like to deal with each category in turn. Entitlement to full registration will primarily be determined by whether or not a person holds a recognised qualification. That will be a qualification which the general council considers provides evidence of reaching a standard of proficiency for the safe and competent practice of chiropractic. In deciding whether it recognises the qualification, the general council will be required to seek the advice of its education committee.
In cases where it wishes to grant recognition, the general council will also be required to obtain the consent of the Privy Council. I will say more about that process of recognition, and withdrawal of recognition, when I come to discuss the role of the education committee.
In addition to holding a recognised qualification, an applicant for full registration would be required to do a number of other things. He must make an application in the form and manner which is required by the general council, and he must pay any fee which may be described. It is of great importance that the applicant satisfies the registrar that he or she is of good character, and is in good physical and mental health. Most of the details determining whether an applicant satisfies those criteria will probably be set down in the rules made by the general council.
I draw the attention of the House to clause 40 of the Bill, which exempts chiropractors from the provisions of the Rehabilitation of Offenders Act 1974. That means that anyone applying for registration will, if asked, be required by law to declare all of his convictions, including those which are otherwise considered to be spent. This is an important provision. The overwhelming majority of chiropractors practise in the private sector, and that position is unlikely to alter markedly even if the Bill succeeds.
Hon. Members will realise that chiropractic is very much a contact form of treatment. Members of the public are entitled to expect a statutory registration scheme to provide them with clear assurances about a practitioner's bona fides.
I have said that entitlement to full registration will be primarily dependent on whether a person holds a recognised qualification. At present, there is no requirement for any person who calls himself a chiropractor to undergo formal training. For that reason, not everybody who is in current practice will necessarily hold a formal qualification. Other chiropractors in Britain may well hold a qualification awarded by a school or an institution in this country or overseas which no longer


exists. That does not automatically mean that those chiropractors are unsuitable for registration, or that they are unsafe and incompetent.
The Bill provides transitional arrangements, known as grandfather arrangements, to enable those practitioners who have been practising chiropractic lawfully, safely and competently for a number of years to apply for full registration. The grandfather provisions in the Bill are identical to those which are embodied in the Osteopaths Act 1993. The requirement is that a practitioner has, for at least five years, spent a substantial part of his working time in the lawful, safe and competent practice of chiropractic. To ensure that a practitioner's experience is recent, no account is taken of any work which was done more than seven years prior to the date on which the register opens.
Applications for full registration under the grandfather arrangements would be permitted only during a two-year period following the opening of the register. After the two-year transitional period has elapsed, applications for full registration would be accepted only on the basis that the applicant holds a recognised qualification and satisfies all of the other criteria which I mentioned earlier. The grandfather provisions are designed to enable the transition from the present system of voluntary registration to a future statutory one to take place smoothly.
The second category of registration is known as conditional registration. That is a purely transitional arrangement, and applications for conditional registration will be permitted only during the two-year period immediately following the opening of the register. Conditional registration would enable a practitioner who again is without a recognised qualification and who is unlikely to muster the five years' lawful, safe and competent practice necessary to apply for full registration still to have a route open by which to enter the registered profession.
There are two broad groups of chiropractors for whom the provision is designed. The first group consists of practitioners who just fail to reach the five years out of seven criterion. They can apply for conditional registration if they can satisfy the registrar that they have acquired four years' experience of lawful, safe and competent practice within a period of less than six years before the opening of the register.
The second group consists of a small number of practitioners who could fall between two stools. They hold a qualification in chiropractic, but it is a qualification about which the general council and the education committee know little. Again, the institution which awarded the qualification may well no longer exist. A practitioner in that category may be unable to satisfy even the four years out of six criterion which I have just described.
Such a chiropractor could be a woman who qualified in chiropractic some years ago from a school or training institution which may no longer exist. She has taken some years out of the profession to bring up a family, and now wants to return to practise. Such people, and others in comparable positions, will be permitted to apply for conditional registration.
The precise criteria will be that they are unable to satisfy the four years out of six criterion, and that they hold a qualification in chiropractic which, while not a recognised qualification, is not something which has been examined

by the education committee of the general council and then refused recognition. It is important to note that I am not seeking to open a back door for applicants who have qualifications which the general council and the education committee have judged to be inadequate.
Any applicant for conditional registration will have to fulfil exactly the same conditions of good health and character as are required for applicants for full registration. In addition, the registrar can require them to take and pass a test of competence to his satisfaction, and require them to enter into a formal undertaking to complete such extra training or acquire such additional experience as he may specify. Applicants will have a maximum of five years after the opening of the register to fulfil the obligations, although the registrar will be able to specify a shorter time scale if he thinks that that is right.
All conditional registrations without exception will lapse automatically at the end of five years, and anyone failing to have a registration made up from conditional to full will automatically cease to be a registered chiropractor.
The final category of registration is provisional and it is a little different. It is intended to allow the general council to require a chiropractor who would otherwise be entitled to full registration to be registered instead for an initial period of one year only with provisional registration.
While registered provisionally, a chiropractor would be allowed to practise only under the supervision of a practitioner who was fully registered under the terms set by the general council. Typically, provisional registration would apply to the first year of practice following the qualification of a student coming straight out of chiropractic college. Obviously, the provision also could be applied to other groups of practitioners. The system of provisional registration is modelled on the system which is already in place among voluntary associations operated by the chiropractic profession in this country. It clearly benefits practitioners and patients alike.
The Bill does not seek to impose automatically a provisional registration scheme, but it allows the general council discretion to introduce a system through rules that it makes in the future. It will have to consult the profession before it makes any such rules. The rules on professional registration would not only require the approval of the Privy Council but would be subject to the negative parliamentary procedure.
The Bill seeks to establish four statutory committees of the general council: the education committee, the investigating committee, the professional conduct committee and the health committee. The education committee will have a general duty to promote high standards of education and training in chiropractic, and to keep the provision of such training under review. Its responsibilities would also cover such things as examinations in chiropractic, tests of competence and post-registration training courses.
The education committee will have the prime responsibility of advising the general council whether a qualification provides evidence of reaching the standard of proficiency required for the safe and competent practice of chiropractic and, consequently, whether that qualification should be formally recognised. In the same way, the committee will also have a responsibility to bring to the attention of the general council any shortcomings in a recognised qualification, especially if they are so serious as to justify action to withdraw recognition.
To help the education committee carry out its statutory duties, the committee will have the power to appoint visitors to go to educational institutions and report back on the adequacy of the training and facilities provided. That provision will be the principal means by which the education committee will be able to acquire first-hand knowledge of the nature and quality of the instruction given.
The Bill also imposes a duty on training institutions which either provide or intend to provide chiropractic education and training to provide the education committee with any information that it might reasonably require in order to carry out its statutory duties. If a training institution fails to comply with such a request, that in itself will be sufficient ground for a recommendation to the general council that recognition be either withheld or withdrawn.
For the sake of completeness, I should perhaps add that a decision to recognise or withdraw recognition from any qualification would require the consent of the Privy Council. To enable the Privy Council to come to a decision on the matter, the general council would be required to provide it with all the information available to the general council and on which the recommendation was based. Where consent is sought for a qualification to be recognised, however, the Privy Council may be content to accept a summary of that information.
Before leaving the subject of education and training, I should mention briefly the existence of different groups of chiropractors in the United Kingdom. The groups have developed along separate and distinct lines over the years. In 1991 they came together to form the chiropractic registration steering group. The differences between the various groups have traditionally been reflected in their different approaches to education and training. One of the fundamental agreements that has been made between members of the steering group is that all United Kingdom schools of chiropractic represented by the various members of the group will achieve a levelling up of standards within five years of legislation to regulate the profession coming into force.
At the heart of the agreement is the intention that the qualifications currently awarded by three main United Kingdom schools of chiropractic—the Anglo-European college in Bournemouth, the McTimoney school and the Witney school—will be granted the status of recognised qualifications. That decision will ultimately be one for the general council and the education committee to take, but I hope that if my Bill is successful the profession will take it as a clear signal that Parliament expects that aspect of the agreement to be honoured.
In the past two weeks I have spent a happy half day in the constituency of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) at the Anglo-European college. A few days ago I visited the Witney school in Oxford to see how its training system operates. The schools have two different approaches, but during each visit I was struck by the dedication, commitment and professionalism of all who were involved.
I turn now to the committee whose role will be to investigate complaints against practitioners. It takes us back to a point made earlier by my hon. Friend the Member for Sutton and Cheam. My Bill establishes an investigative and disciplinary procedure to deal with three sorts of allegation: first, allegations of unacceptable professional

conduct; secondly, allegations of professional incompetence; and, thirdly, allegations that a chiropractor has been convicted in the United Kingdom of a criminal offence or is unfit to practise due to his physical or mental condition.
To ensure that the fitness-to-practise scheme has some real teeth, it will be an offence for anyone not to comply with a request from the professional conduct committee, the health committee or the appeal tribunal to attend a hearing to give evidence or produce documents. As with the offence of wrongly claiming to be a chiropractor, that offence would be punishable on summary conviction with a £5,000 fine—level 5 on the standard scale.
Let me summarise how a complaint from an individual would be handled. First, the general council could appoint a screener to decide whether the case even came within the scope of the fitness-to-practise machinery. As my hon. Friend the Member for Sutton and Cheam said, a complaint could be made about a chiropractor that had nothing to do with the general council or the registration scheme of the profession. Someone could complain bitterly that his chiropractor was an active member of a particular political party, for instance. It would be the job of the screener to decide whether the nature of the complaint brought it within the statutory scheme. If it did, and only if it did, the investigating committee, which acts as the CID and Crown Prosecution Service of the scheme, would take over the matter and conduct a preliminary investigation.
The investigating committee would then gather information and evidence, look at that evidence and decide whether there was a case to answer. If there was a case to answer, the investigating committee would determine whether the professional conduct committee or the health committee was the appropriate one to deal with that case.
The investigating committee could suspend registration and, therefore, the ability to practise pending or during investigation, if it decided that it was necessary for the protection of the public. The obvious case in which that power would be invoked would be a serious allegation against a chiropractor, for example, of sexual assault on a patient. There would then be an urgent need to be absolutely certain that the public were protected.
The Bill specifies that an interim suspension imposed by the investigating committee would have a maximum duration of only two months. The reason for that is to make sure that the investigating committee gets on with its job and refers cases onwards quickly and efficiently for resolution by either the professional conduct committee or the health committee. Those committees in turn will have similar powers of interim suspension for the same reasons of protection of the public, but no maximum duration is set. So suspension imposed by the investigating committee could be maintained by either the professional conduct committee or the health committee if it thought that that was right.
A practitioner would have a right to appeal against suspension by any of the committees by going to the High Court or its equivalent in Scotland and Northern Ireland. However, there would be no appeal against the interim suspension imposed in the first instance by the investigating committee. I judge that the two-month maximum duration is adequate protection there.
Any allegation of unacceptable professional conduct, professional incompetence or that a chiropractor had been convicted in this country of a criminal offence would be referred to the professional conduct committee. The practitioner would be entitled to know the details of the


case against him, and would have the right to a hearing and legal representation if he or she so chose. The committee will be barred from taking action when it is proved that the offence is irrelevant to the practitioner's fitness to practise. That deals with the point of my hon. Friend the Member for Sutton and Cheam about a chiropractor who is convicted for speeding.
If the professional conduct committee finds against a practitioner, it will be given certain disciplinary powers and will be able to strike his or her name off the register. It will also have the power to suspend a practitioner for up to three years, to impose conditions on future registration or simply to admonish the chiropractor.
During the suspension period, the professional conduct committee will be able to extend suspension for a further three years or impose conditions for registration once it has expired. Again, the chiropractor concerned would have the right to a hearing and to legal representation.
The idea is that the power to extend the suspension period would apply to cases which had been heard and determined by the professional conduct committee, which had imposed a suspension but further, and perhaps even more serious allegations, had then come to light. The committee would be able to extend the suspension period, without the case having to begin again at the start of the procedure.

Mr. Harold Elletson: I do not wish to deflect my hon. Friend from his theme, but he is talking in great detail about the functions of the general council's various committees, and there is a more fundamental concern about financing the council and especially about the initial start-up costs. I understand that no Government money will be available to assist with that. Will he deal with those start-up costs, and does he feel that the general council will be able to rely on using some of its existing rolling stock and funds from existing voluntary organisations?

Mr. Lidington: Unless my hon. Friend the Minister has changed his mind since we last spoke, I understand that no Government money will be available for the establishment of the General Chiropractic Council. It will therefore be up to the profession to finance the start-up costs from its resources. That profession, or part of it, is strongly behind the scheme for statutory registration that is embodied in the Bill and sees it as a way to ensure that patients are adequately protected and that the good name of the British chiropractic profession, which it has built up painstakingly for some years, is also protected. The profession feels that it is able and willing to meet the costs that will be incurred.
The health committee will consider cases in which a chiropractor's physical or mental health gives cause for concern. The chiropractor involved will again have the right to a hearing and to legal representation. The health committee and the professional conduct committee will have different philosophies and remits. The PCC will have powers to punish practitioners for wrongdoing, but the health committee will exist to protect the public against chiropractors who become a potential risk to their patients through ill health.
If the health committee finds a case proven against a practitioner, it must suspend him or her, or impose conditions on registration for a definite period of up to

three years. The committee will be able to renew orders of that sort, as long as they are considered necessary for the safety of the public.
At first sight that sentence might seem draconian as it does not allow the practitioner the chance to renew his practice. However, the case may be reviewed and that will provide a sufficient safeguard for both practitioners and the public. Let us consider the example of a chiropractor who suffers a mental breakdown. It is not in his interests or that of his patients that he continues to treat them and he should be suspended. With time or treatment, however, his condition might improve to the point that the health committee, after reviewing the case, would feel able to remove the suspension and allow him to practise again. Initially, the practitioner might be subject to conditions, for example, that he work only under the supervision of another chiropractor or as part of a group practice.
When a chiropractor wishes to contest a decision taken by the health committee, he or she would have the right of appeal to an independent appeals tribunal, consisting of an experienced lawyer, a medical practitioner and a chiropractor. The tribunal's function will be to provide a body independent of the general council to deal with all appeals from the health committee. To provide a double assurance, a further appeal could be made to the Privy Council on points of law.
I apologise for the length of time that I have taken. The Chiropractors Bill, like the Osteopaths Act 1993, is rather a lengthy document for a piece of private Member's legislation and it is important that the House should understand what is proposed.
Before I sit down, I must acknowledge the debt of thanks that I owe to the many people who have offered me help, advice and support in recent months. Members of the chiropractic profession and the steering group, under the chairmanship of Ian Hutchinson, have been enthusiastic, supportive and full of information. The team of officials at the Department of Health who helped with the preparation of the Bill—led by Mr. Kenneth Allan—put up with my questions and responded promptly and efficiently to my requests for information and briefing. It got on with the job of assisting me to draft the Bill with great expedition, and I am grateful.
At the risk of turning this into a bridegroom's speech, may I say that thanks are also due to my supporters on both sides of the House. I have been struck by the extent to which the measure has support across party lines—from my hon. Friend the Under-Secretary of State, from the hon. Member for Bristol, South (Ms Primarolo) on behalf of the Opposition Front Bench and from the hon. Member for Rochdale (Ms Lynne), who is her party's spokesman on health matters and has agreed to act as one of my sponsors. I see that the hon. Member for Preston (Mrs. Wise) is also in her place. Thanks are due to her, as well as to those of my right hon. and hon. Friends who supported me in introducing the measure.
Although the Bill is quite long and technical, it is designed to deal with a very real problem which is a challenge to our health care. Chiropractic, like other forms of complementary medicine, has come of age and increasingly is seen to offer treatments that are efficacious and valuable to orthodox medicine. We need to ensure that the reputations of good and dedicated practitioners are protected and that patients are safeguarded.
In recent weeks I have met two patients. One was a middle-aged man—a self-employed builder—who told me


that orthodox medicine seemed to have failed him and that he had practically been carried into the chiropractor's consulting room, but had managed to walk out, which not only meant freedom from pain, but the ability to continue as a builder and to earn his livelihood.
The other patient was a lady suffering from a muscle-wasting disease. She knew that there was no miracle cure, but regular chiropractic treatments had improved the quality of her life to an extent that she, her friends and family and originally even her doctor had thought impossible. She enjoyed independence and got more out of life because of that.
When medical matters are debated, both in Parliament and in the media, we tend to focus on the glamorous side such as organ transplants and pioneering surgical techniques. We forget the millions of people who suffer pai—noften excruciating pain—from troubles with their backs or joints in other parts of the body. It is in the interests of patients such as those two whose cases I have just mentioned that I have introduced this Bill and why I commend it to the House.

Ms Liz Lynne: I shall not detain the House for long because, as the hon. Member for Aylesbury (Mr. Lidington) said, the Bill has all-party support. I commend him for the length and breadth of his speech. On behalf of my party I am pleased to welcome the Bill. I am also pleased to be a sponsor of the Bill and I wish the hon. Member for Aylesbury every success in steering it through the House.
I have long been a user and advocate of alternative and complementary therapies and I welcome the move represented by the Bill and the Osteopaths Act 1993 to give official recognition to those therapies. According to one document that I have read, chiropractors are the third largest health care providers in the western world. Clearly, they are not a marginal or eccentric form of health care.
The Bill marks an attempt both to take chiropractors seriously and to help build confidence among the public in the profession. I regret, however, that it does not improve access to chiropractors on the national health service. I am sure that many hon. Members' constituents have written to them to complain about their local health authority failing to fund health care services out of the extra-contractual referrals budget. Alternative therapies are one of the many services that have been denied to patients because of the tight rein on ECR budgets. That restriction on the availability of chiropractic and other alternative therapies is despite the fact that treatment in a recent Medical Research Council trial was found to be much more effective than hospital out-patient treatment for lower back pain, especially for patients in chronic or severe pain.

Mr. Piers Merchant: Will the hon. Lady give way?

Ms Lynne: I should like to get on with my speech. The hon. Member for Aylesbury has taken so long to explain the Bill and gone into such detail that I shall not take interventions, if hon. Members will forgive me. The Bill has all-party support.
The ability effectively to treat members of the public with back pain will be no mean achievement. According to figures provided by the chiropractic registration steering group, 310,000 people in the United Kingdom are off work

each day with back pain. That costs the country more than £3 billion a year in lost production. Disability from lower back pain is increasing faster than any other form of disability.
In other European countries, chiropractic is part of the overall process of treating back pain. In Sweden, for example, many chiropractors work with orthopaedic surgeons in hospitals where it is often found that chiropractic is a preferable and cheaper option to surgery. It is important to remember that. In the United States, more than 45,000 chiropractors are regulated and licensed by the same authorities as GPs and their fees can be paid under Medicare or Medicaid. In many other countries, chiropractors are registered and their training programmes are licensed.
The Bill brings us into line with many of our European partners. At present, anyone can call himself or herself a chiropractor and practise as one. As currently some 900 chiropractors are registered in this country, that should be a cause of great concern. Given the increasing interest in alternative therapies, it is clearly time to take action. For all the reasons that I have listed, the Bill is to be welcomed.
Nevertheless, I should like more consideration to be given to the rights of patients to know what treatment they can expect and how to complain when their expectations are not met. I should also like consideration to be given to establishing an ombudsman for all alternative therapies, although the Institute of Complementary Therapy hopes to be able to carry out that role on a non-statutory basis.
As the Bill is modelled on the example of the Osteopaths Act, it would be useful to have a report on the success of that Act during our discussions in Committee. If, for example, many osteopaths have not registered but are continuing to practise, we may have to consider tightening the rules as I suggested during the debate on the Osteopaths Bill. I am still convinced that displaying a practitioner's registration in his or her place of work would enable potential patients to know immediately whether the practitioner was suitably qualified.
Despite those small reservations, I very much welcome the Bill and wish it every success in its passage through Parliament. I hope that more resources can be found to enable more NHS patients to make use of chiropractic services.

Mr. Harold Elletson: I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on introducing the Bill and on the great detail in which he took the House through its various provisions. This is a matter of great concern to many people throughout the country, particularly many of my constituents who have written to me on that subject.
As we all know, many people suffer from back and neck trouble and have occasion to consult either an osteopath or a chiropractor. Many of our hon. Friends also suffer from back problems, particularly those of us fortunate enough to be involved in the backbreaking work of the Standing Committee on the Local Government etc (Scotland) Bill.
As my hon. Friend the Member for Aylesbury pointed out, chiropractic is the second most widely used branch of complementary medicine and some 25,000 people in this country consult a chiropractor every week. Of most concern to us, however, is the fact that, although the


overwhelming majority of people who practise chiropractic do an extremely good job, when people consult a chiropractor they cannot be sure that the person treating them is properly competent. That is frightening because treatment is applied manually directly to the spine, which is connected to the central nervous system. I suppose that the equivalent of allowing an untrained person manually to treat the central nervous system would be to let the Labour party loose on the economy.
If treatment goes wrong, the only recourse that a patient has is through the common law. The Bill is important because it seeks to establish statutory regulations that would give patients the assurance that they need that the person treating them is properly qualified. As my hon. Friend said earlier, the current voluntary system cannot provide that degree of assurance.
I understand that many hon. Members, particularly in the present climate, will be somewhat hesitant about introducing an extra system of regulation. The report of the King's Fund deals with that subject. Unfortunately, its chief executive is called Robert Maxwell. It is not his fault but I was alarmed to see that the chief executive of the King's or any other fund should be called Robert Maxwell. He is, however, a far more distinguished, competent and honest person than the former Robert Maxwell, who is so well known to all of us.
The chief executive rightly said that any branch of complementary medicine that met three criteria, which he outlined, should be recognised and regulated by statute. First, the therapeutic practice concerned should rest on solid foundations and science and have examinable knowledge and skills. Secondly, it must be able to demonstrate by objective standards that it can cure or alleviate pain and suffering when practised skilfully, and that it has power to do harm in the wrong hands. Thirdly, there must be significant public demand for it; it must be shown that the public require help in differentiating reliable from unreliable practice and would be best protected by publicly accountable self-regulation by the professional concerned. The chief executive said:
These criteria do not apply equally to all branches of complementary medicine but they do apply to chiropractic as to osteopathy.
The Bill provides an appropriate level of regulation. My hon. Friend has been careful not to overregulate and introduce an unacceptable amount of bureaucracy, and the Bill ensures that the general council is self-financing. He has sought to introduce a light-touch form of regulation. Essentially, the Bill is not so much about regulating the practice of chiropractic as about dealing with the whole question of the closure of title, the use of the word "chiropractor". That is the essence of the matter. When a patient goes to a person who holds himself out as a chiropractor, the patient should be absolutely sure that he can rely on a certain level of service and specific standards.
I congratulate my hon. Friend on his Bill. I offer him my full support and commend the Bill to the House.

Mrs. Audrey Wise: I welcome the Bill, which is both desirable and necessary, and important for the future of health care. It is desirable because it deals with an important treatment that is increasingly widely used and that can be extremely beneficial, but that could be harmful

in the wrong hands. I speak as someone who uses chiropractic. My interest was first aroused simply by reading and when the representatives of the British Chiropractic Association came to the House to give a demonstration to hon. Members, I decided to attend. That extremely interesting demonstration aroused my interest even more, since when I have read a considerable amount on the subject.
The Medical Research Council carried out some famous research—a randomised controlled trial, which lasted at least two years and from which chiropractic emerged with flying colours as an extremely effective way to treat a great many problems. It is a legitimate form of treatment, but until now it has not been properly recognised as fully legitimate. When I developed some problems with my shoulder, I thought, "Here is your chance to show practical as well as theoretical support and to demonstrate that you have confidence rather than just saying so."
I put myself in the hands of a local chiropractor and I was immeasurably impressed by the treatment and the style of treatment. My mother and my son-in-law also have treatment, which means that three generations of my family are benefiting from chiropractic. The treatment is suitable and important for all ages.
I am particularly impressed by the fact that chiropractic is a communicative form of treatment. One is not simply a passive recipient but is involved and informed and leaves the chiropractor knowing a great deal more about one's body and with suggestions about self-help. That is an important feature that is rarely a part of orthodox medicine, which often regards people as passive receivers of treatment. In that respect, chiropractic has lessons for health care in general. The chiropractor seeks to enlist a person's body and physical resources in helping with the treatment.
In my experience, chiropractors are anxious to be part of the general medical or health care team and communicate with general practitioners. Some GPs welcome that communication but others probably put it in the bin. I hope that that latter practice will end. The recognition afforded by registration under the procedures set out in the Bill will help to establish chiropractic not only with the public but with the other health care professionals.
The Bill is necessary as well as desirable because of the passing of the Osteopaths Act 1993. I support that legislation but I recognise that it poses dangers for chiropractic and for people who consult chiropractors. Some people who are unable to call themselves osteopaths and cannot be registered if their qualifications do not warrant it may decide to call themselves chiropractors. The fact that that profession has been regulated makes it even more important to regulate the closely allied profession. It would be an undesirable spin-off from an otherwise good Act if people seeking chiropractic treatment were open to treatment by charlatans who are not properly trained and qualified.
For two reasons, the Bill is urgent and important for the future of health care. The first reason is that, as has been said, an enormous number of people suffer from back pain and from troubles related to the spine and the skeletal framework. People who suffer from such problems often have difficulty because those problems are not always obvious to the layman's eye. They are not always obvious to people such as Secretaries of State for Social Security, who are apt to add to the all-too-common view that suffering from back pain is just a form of malingering.


Those of us who are interested in the Bill know that that is not so, that back pain is extremely disabling and that, rather than being fobbed off with painkillers, people with back pain, which can lead to chronic disability, should have full positive treatment.
Orthodox medicine does not offer much to those who suffer from such problems. That was borne out by the results of the Medical Research Council's randomised controlled trial to which I have referred. Chiropractic is a good form of treatment.
The Bill is important to the future of health care. I see it as the first step towards making chiropractic more generally available. In an otherwise good and informative speech, the hon. Member for Aylesbury (Mr. Lidington), who introduced the Bill, made a throwaway remark: that most chiropractors practise in the private sector and that is unlikely to change. That suggestion is unwarranted, because it carries with it the implication that the Bill will make chiropractic safe and accessible to those who can pay. I want chiropractic to be safe and accessible to all who need it. Those two are not the same thing.
In my advice sessions—most hon. Members probably find the same—I frequently see people who are suffering from severe back problems, which often arise from occupational injury or occupational distortion. Frequently, it seems patently obvious that the person sitting opposite me would benefit enormously from chiropractic treatment—I feel that even more strongly since I have become a user of chiropractic—but what can be said to them? Often, the people who are suffering have lost the capacity to earn their living, and often the way that they earned their living in the first place is the cause of their incapacity. Why should the House assume that chiropractic should be available only to a person who can pay? Clearly, it would not be proper or possible to make chiropractic available widely on the national health service unless—

Mr. Merchant: Will the hon. Lady give way?

Mrs. Wise: I think that I saw the hon. Member rise to catch the Speaker's eye. If that is so, he can make his point in his own speech. If he wants to intervene and not make a speech, I will gladly give way.
It would not be proper or possible to make chiropractic widely available to patients free of charge through the NHS unless the profession were regulated in the way proposed in the Bill. I see that as a valuable step on the way to making chiropractic fully recognised and acceptable to people, regardless of their ability to pay. In saying that, I must make it clear that that is not to be misunderstood. I do not want chiropractic, when it becomes available through the NHS, to be subsumed under the auspices of the medical profession. That would not be appropriate. Chiropractic is a fully trained profession in its own right. I believe that its practitioners are amply capable of autonomous practice, provided that they are regulated. If the hon. Member for Aylesbury had said that chiropractors would remain autonomous practitioners, as they are at present, I would have whole-heartedly agreed. Perhaps he had that in mind when he made his rather throwaway remark.
Being an autonomous practitioner should not imply that one will see patients only if they can pay directly. I believe that the Bill opens the door to the full recognition of a valuable profession, able to do untold good to many millions of people. It is a growing profession. People are voting with their feet, even though the treatment is

available only privately except on the odd occasion. My local practice is extremely busy. People often make great sacrifices to consult chiropractors because they find the treatment so valuable. I look forward to making it even safer through the proper registration of practitioners. I look forward to the Bill being the first step along the road to making chiropractic accessible to all, regardless of ability to pay.

Mr. Ian McCartney: On a point of order, Mr. Deputy Speaker. I thank the House for indulging me for a few moments. Have you, Mr. Deputy Speaker, received any notice in relation to early-day motions 636, 637 and 638, about the conspiracy at the heart of the North Hertfordshire NHS trust on the privatisation of its pathology services and the involvement of senior regional health authority officials—

Mr. Deputy Speaker: Order. Did I understand the hon. Gentleman to ask in his opening remarks whether the Chair had received any information?

Mr. McCartney: I want to know whether you, Mr. Deputy Speaker, have had notice of a statement in respect of the serious issues raised in those early-day motions, in particular the involvement of a senior regional health authority official in secretly promoting the privatisation of pathology services—

Mr. Deputy Speaker: Order. That is not really a point of order for the Chair.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): Further to that point of order, Mr. Deputy Speaker—

Mr. Deputy Speaker: Order. There cannot be a further point of order to a point of order that never was.

Mr. David Atkinson: I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his good fortune in the ballot for private Members' Bills, his choice of Bill and his impressive presentation of it today. As he may know, I was personally committed to introducing it, were I to have been so fortunate. I am grateful for his invitation to be a sponsor.
Chiropractic was founded in the belief that a great many every-day disorders are caused by spinal defects impeding the work of our immune system. My personal experience, and that of many of my constituents and those of many hon. Members who have spoken in the debate, shows that a growing number of people are fully convinced of the benefits of chiropractic care. I am absolutely delighted that, at last, the prospect of the proper regulation, registration and, above all, recognition of chiropractors is now in sight. My hon. Friend's Bill, when it passes into legislation, will represent a fitting celebration of the centenary of chiropractic next year.
I am privileged to have located in my constituency, as my hon. Friend has already informed the House, the Anglo-European College of Chiropractic. It is one of three chiropractic colleges in the country and the only one to offer a university-validated five-year BSc honours degree course—a course that has been designated by the Department for Education to receive mandatory grants. I know that my hon. Friend has already told the House that he was impressed by what he saw at the college when he


visited it last week. As a result of his Bill, today's graduates, their predecessors and successors will have their long and thorough training and education vindicated and recognised.
As you will know, Mr. Deputy Speaker, Bournemouth is a well-deserved favourite venue for the three political parties, which have their annual conferences at the Bournemouth international centre. When hon. Members visit Bournemouth to take part in those conferences, I very much hope that they will use that opportunity to visit the college in Parkwood road in Boscombe. I know that they will be welcome to see the impressive work and education that is undertaken there.
My hon. Friend's Bill is long overdue. As he has reminded us, the path to its introduction was well paved by the Osteopaths Act 1993, which was introduced by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) last year. If no hon. Member had selected the Bill this year, chiropractic would have remained in the limbo land of non-recognition for another year and perhaps more years to come. That still applies to all the other leading complementary treatments, such as acupuncture, homeopathy, herbalism, aromatherapy and reflexology—all of which have important contributions to make to the health services.
To its credit, the British Medical Association recognised the position in a report published last year, which called for the compulsory registration of all the leading complementary medicines. That represented a welcome about-face from the BMA's 1986 report, which described such medicines as
a reversion to primitive beliefs.
That, of course, was a veiled recognition that many of them are far older and more established than many current, conventional remedies.
The BMA was only responding to a growing number of our constituents who—as the hon. Member for Preston (Mrs. Wise) said—have voted with their feet. Unfortunately, in some cases they have voted with their pockets as well, in finding relief and recovery when orthodox medicines have failed. The BMA was also responding to a growing number of its own members—general practitioners—who are referring patients to registered complementary practitioners such as chiropractors, employing such practitioners and, indeed, becoming registered complementary practitioners themselves. If they are fundholders, they are providing their patients with a free NHS service, contrary to the impression given by the hon. Members for Preston and for Rochdale (Ms Lynne).
Each of those professions, however, waits its turn in the queue for private Members' legislation, hoping for a Bill like this, or like last year's Osteopaths Bill. The process could—indeed, will—take years, which is entirely unacceptable. The Government should tolerate the current position no longer. A way forward has been provided by the enactment of the Osteopaths Bill and it will be confirmed by the passage of this Bill, which will emphasise the need to reform the Act that governs the professions supplementary to medicine.
Physiotherapists, for example, now suggest that the present Council for the Professions Supplementary to Medicine is not working well. They consider it unfair that complementary medicines such as osteopathy and chiropractic should now achieve clearer recognition and

more straightforward self-governance than they themselves enjoy. Such long-overdue reforms, however, can be undertaken only by the Government, in Government time.
Any legislation amending the Professions Supplementary to Medicines Act 1960 can surely embrace the BMA's call for regulation of all the leading complementary medicines. My hon. Friend the Minister can invite the Research Council for Complementary Medicine to make appropriate recommendations to him; alternatively, he can announce a Government inquiry into the most popular complementary medicines to subject them to scientific validation, with the ultimate aim of integrating orthodox with complementary medicines. Such integration has already taken place in the Netherlands. To do nothing, however, is no longer an option. I look forward to my hon. Friend the Minister's response.
My hon. Friend the Member for Aylesbury has made an excellent case for the benefits for patients that would undoubtedly result from the passage of his Bill. As he has said, it will effectively outlaw quacks who can set themselves up in a practice with a chiropractic nameplate, with no qualifications or competence and providing no realistic opportunity of redress if anything goes wrong.
I shall never forget a constituent who came to my surgery several years ago because of permanent disabilities arising from his so-called treatment—for which, of course, he was obliged to pay—by someone who was neither qualified nor competent. His was a very sad situation. Let me emphasise that that practitioner was unqualified and clearly incompetent. My hon. Friend's Bill will effectively end such problems by ending the irresponsible use of the term "chiropractor".
I hope that the Bill will encourage health authorities, hospital staff and yet more general practices to work more closely with the chiropractic profession. Chiropractic, osteopathy and other such complementary therapies require neither the expensive equipment used in NHS treatments nor the increasingly expensive use of drugs. Their statutory recognition will lead to enormous savings in our health services.
I believe that more widespread use of complementary treatments will also lead to greater accuracy in the diagnosis of disorders that still baffle the NHS, such as allergies and myalgic encephalomyelitis, or ME. I hope that the Bill will encourage companies to become more aware of the opportunities for them to refer employees to chiropractic. My hon. Friend the Minister expects to receive in the summer a report from his Department's clinical standards advisory committee inquiry into back pain. It will probably confirm that tens of thousands of people are off work with back pain every day, costing billions of pounds in lost production each year.
I hope that the Bill will encourage more private insurers to cover chiropractic treatment, because they will judge it more cost-effective than orthodox medical treatment. I understand that more than 30 private United Kingdom health insurance companies now reimburse the cost of such treatment.
Let me end by placing my hon. Friend's initiative within the wider context of the position of the chiropractic profession in Europe, about which my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) inquired. Unfortunately, enormous differences remain in Europe between the practice and controls of complementary medicines, which range from the very liberal to the very restrictive. Equally wide is the variation in the


availability of access for patients to such medicines through national health services. There is no single market for health for European Union citizens. Surely, as citizens, we should be entitled to benefit from the same standard of complementary medicine—as well as orthodox medicine—in every member state.
It was for those reasons that, three weeks ago at the last session of the Parliamentary Assembly of the Council of Europe in Strasbourg, I tabled a motion for a resolution, which will now go before the appropriate committee for a report and a recommendation. It calls for a new European convention to provide every citizen with the right to benefit from complementary medicines and for a common approach to the recognition and registration of practitioners. Such a convention will, of course, require member Governments such as ours to implement its terms and conditions in national laws. There will then be no need for the piecemeal approach, in this country and throughout Europe, which has made my hon. Friend's Bill so necessary.
In the meantime, I wish my hon. Friend's Bill every success. I hope that it will have an unopposed and unimpeded passage through both Houses.

Mr. Piers Merchant: I am delighted to be able to participate in this debate because I was so impressed by the competent and effective way in which my hon. Friend the Member for Aylesbury (Mr. Lidington) introduced the Bill this morning. I congratulate him on his wisdom in selecting this topic, which had become overdue for consideration. Unlike him, I rise without particular expertise in the topic—certainly not the expertise that my hon. Friend displayed. Until last summer, I knew little more than the fact that there was a difference between chiropractic and chiropody. I had no idea what techniques the practitioners carried out and I merely include chiropractic in the category of alternative medicine.
I am glad to say that I was enlightened by a constituent, Clare Metcalfe, who runs the Beckenham and Bromley chiropractic clinic. In the summer, she had the wisdom to invite me to her clinic to see the work that she does and to learn a little about the art. I was extremely impressed, not least by the scientific approach behind this form of medicine. I was also impressed by the high professional standards which were clearly evident at the clinic and by the arguments for registration which Clare Metcalfe and the vast majority of her professional colleagues are strongly behind.
I started with a degree of suspicion about alternative medicine—a suspicion that is shared by many people. It probably comes from the prejudices that are inculcated in a modern scientific education which tends to exclude anything that is not orthodox. However, it is important always to retain an open mind and the more I look at the various practices of alternative medicine that are available, the more I see that there are options which are away from the orthodox path but clearly carry much merit. I very much accept the redefinition of chiropractic as a complementary form of medicine rather than an alternative, the stress being on the fact that it runs in parallel to traditional medicine rather than against it. Treatment can easily be carried out in harmony with existing orthodox medical practice.
I have learnt that there are about 900 chiropractors in this country and that they treat about 75,000 patients a week. Chiropractic is a much larger area of complementary medicine than I had previously realised. I should like to correct the hon. Members for Rochdale (Ms Lynne) and for Preston (Mrs. Wise), who were not prepared to allow me to intervene. I intended to do so in a gentle manner merely to point out that it is possible to have treatment under the NHS system at present.
The hon. Member for Rochdale gave the impression that the Bill would do nothing to encourage treatment under the NHS. I beg to differ. Introducing a formal system of registration will automatically increase the status and prestige of this form of medicine and, in doing so, will encourage GPs to exercise their right to refer. That is significant because one of the barriers to the expansion and growth of respectability of chiropractic has been that many GPs have not been prepared to refer patients and in some cases they have not been prepared to acknowledge the benefits of chiropractic. The Bill will help to involve the NHS more.
The hon. Member for Preston was simply wrong when she stated as a matter of fact that people have to pay for chiropractic. That is not the case. The practice I visited was receiving increasing numbers of referrals directly from GPs. GPs with fundholding budgets are able to use the staff element of the budget to pay directly for the treatment so the patient is treated on the NHS and does not have to pay. Non-fundholding GPs are able, with the agreement of the family health services authority, to transfer the cost of treatment to the NHS. I do not know whether any hospitals are using chiropractic. However, it is possible for hospitals to include chiropractic as long as a local decision has been made to that effect.

Mr. Alan Duncan: In support of my hon. Friend's argument and to give clear evidence to back up what he says, may I point out to him that my medium-sized surgery in Uppingham provides physiotherapy, chiropractic and even acupuncture on the NHS? It is not yet a fundholding surgery, although I hope that it will be in due course. I also hope that acupuncture will in due course be the subject of a Bill similar to this one.

Mr. Merchant: I am delighted to hear my hon. Friend's information on that point. It is further evidence that chiropractic is increasingly being accepted within the NHS system. The driving force will be the demand and the recognition of the demand for these forms of complementary medicine. The Bill has an important part to play in that it increasingly puts chiropractic on a formal basis.
My hon. Friend the Member for Rutland and Melton (Mr. Duncan) may know that three studies have recently been carried out which have a bearing on the Bill and on this form of medicine. The first is the Medical Research Council's study, to which the hon. Member for Preston referred. It was reported in the 1990 British Medical Journal. A team of epidemiologists and a rheumatologist studied 741 patients between the ages of 18 and 65. They compared the treatment received in hospital through traditional medicine with the treatment received frorn chiropractors. The study revealed that only one of the 11 hospital centres could perform better than the chiropractors. There was an insignificant difference between the performance of two of the hospitals and the chiropractors. The chiropractors were "significantly more effective" than


eight of the hospitals. That demonstrates clearly to me that traditional medicine has recognised the benefits of chiropractic.
The second formal study to which I shall refer, which is not a medical one, is the King's Fund study which looked at chiropractic. The researchers formed the view that registration along the lines proposed in the Bill would distinctly enhance the practice. The third study is a Department of Health-funded study by the medical care research unit at the university of Sheffield. It is looking at the impact on the NHS of the provision of chiropractic as an alternative. It is looking at, for example, the impact on GP prescribing, on the drugs budget, on hospital referrals, on patient satisfaction and on repeat attendances. The study may well demonstrate that chiropractic has a great deal to offer in terms not only of health but of the efficient use of resources within the health service system.
Why is legislation required? Is legislation automatically needed just because one recognises that a part of complementary medicine is useful? The Bill is supported by chiropractors themselves. They recognise that the registration system proposed in the Bill will bring protection to patients and to chiropractors. I shall deal with the two points separately, although they are linked to some extent.
The potential patient needs to know that, if he visits a chiropractor, he can be assured of a basic level of competence. As we have heard this morning, although the vast majority of chiropractors live up to that standard, there is nothing preventing someone from starting a practice and advertising it although he has no competence at all. The Bill will assure a basic level of competence for the patient.
The Bill will also enable patients to know that the chiropractors whom they visit have been trained to a certain standard and can provide care of a certain minimum quality. It would mean that the chiropractors' training was recognised and approved and would not therefore take the would-be chiropractor in a totally different direction from mainstream practice.
In addition, patients need to know that they can trust a chiropractor. The Bill would ensure a proper system of registration which would bring with it a proper system of discipline, thus ensuring that there were no people practising who should not be doing so.
What about chiropractors themselves? The most important thing is that the Bill would give them a clear status and protection against their reputation being somehow impaired by people who set themselves up as chiropractors without having the right to do so. Let me cite an example. Under the existing law, in the very unlikely event of my losing my seat, I could decide to make as little money by setting myself up as a chiropractor. Without any legal hindrance, I could have a little brass plate made and stuck on the front of my house and describe myself as a chiropractor. I could invite people into my front room and treat them.
In losing my seat, I might have become mentally deranged and I might start behaving rather peculiarly with my patients and doing all sorts of strange things to them which could harm them medically, apart from having little to do with the art of chiropractic. Even worse, I might develop a very unhealthy interest in massaging the backs of young ladies and might invite them into my front room

solely for that purpose while posing as a practitioner of alternative medicine. As long as I broke no other law, I could not be struck off because there would be no register from which to strike my name.
The system of registration would involve a system of committees observing practitioners and thus a system of proper discipline. The public would be safeguarded, and future and existing chiropractors could be assured that anyone coming into their sphere of expertise would have been properly trained according to the standards set by chiropractors themselves. Insurance would be properly taken care of by the profession's official body and, as I said earlier, treatment would be more widely available under the NHS.

Mr. Elletson: The doctor who runs the Blackpool chiropractic centre in my constituency is an American. He is also a general medical practitioner who specialises in chiropractic. When he arrived in this country he was astonished to find that, unlike America, where very strict regulations govern chiropractic, there is nothing here to protect the public from charlatans. Why does my hon. Friend believe that that is so? The Bill is trying to ensure that we are protected from charlatans. It would mean that Britain would no longer be out on a limb and so unusual in having no regulation governing this practice.

Mr. Merchant: I agree with my hon. Friend. We need to protect the public and the profession against the small number of quacks who are always liable to be attracted to something from which they might be able to make money without performing a service. The same is true of many other areas of activity.
I am in no sense a regulator; I do not wish to introduce rules, regulations or legislation unless absolutely necessary, but in medicine, when we are dealing with people who are vulnerable, especially when they are ill and need treatment, the public are very much at the mercy of people who set themselves up as being able to help in some way. Unless there is a formal system to prevent that, the public are in potential danger. The Bill deals neatly with that problem.
The system of registration is well tried and tested and strikes me as a sensible way of tackling the problem. It does so with sensitivity because it does not seek to intervene in the medical aspect or determine exactly what chiropractic is or should be. Instead, it allows the profession to decide that, as it should. As my hon. Friend the Member for Blackpool, North (Mr. Elletson) said, the Bill seeks merely to define and limit the use of the word "chiropractor". In the proposed legislation, the so-called "grandfather clauses" would also protect the practitioners who have had some training but who do not immediately fall within its strict requirements. It offers a gentle way in which to proceed which would nevertheless achieve the objective without discriminating against genuine chiropractors who have been practising but have not gone through the mainstream system.
The education committee will ensure that training is promoted and that standards are kept at a high level. The investigating committee will in various ways protect against unacceptable professional conduct and professional incompetence and will prevent chiropractors who have been convicted of criminal offences continuing to practise.


It will also regulate those who are unfit because of a medical or mental condition. High standards will be ensured for practitioners and the public.
The Bill will give official respectability to a profession which is already a great success and which is recognised as such by the general public. It will provide faith in a relatively newly accepted form of medicine. In particular, it will enable chiropractic to grow within a formal framework which will nevertheless not place draconian restrictions on it. It will protect without limiting, which is the essence of good regulation. For those reasons, I have no hesitation in supporting this excellent Bill, and I wish it a swift passage through Parliament.

Lady Olga Maitland: I am sorry that my hon. Friend the Member for Aylesbury (Mr. Lidington) is not in the Chamber at the moment because I wish to put on record my congratulations to him on his masterly delivery of his brief and on his stylish presentation.
The Bill is long overdue. Last year, I had the honour to serve on the Committee that debated the Osteopaths Act 1993 and I was well aware that this Bill, which was waiting in the wings, would have its day. That day has now come. It is right that the Bill should not have been confused or merged with the Osteopaths Act for the sake of convenience, as some people suggested. Osteopathy and chiropractic are different disciplines, although they operate within the same sphere. Chiropractic, however, stands on its own merits.
I welcome the fact that the legislation will give doctors confidence which they might not otherwise have had to refer their patients to chiropractors because they will know that the practitioners are registered and have achieved the highest professional standards. Such a development is welcomed by the British Medical Association and the Royal College of Surgeons. In turn, patients will be protected in the knowledge that their practitioner has been trained to high standards. As has been explained, a practitioner could also be subject to professional discipline should things go wrong.
Chiropractic is a growing profession. As has already been said, there are 900 chiropractors on voluntary lists, which are maintained by three organisations, and it is estimated that each week 75,000 patients consult chiropractors. The history of chiropractic goes back a long way. It began in the past century in Iowa in the United States and celebrates its centenary next year. There are more chiropractors in the United States than there are osteopaths—the reverse of Britain. None the less, a Which? survey in 1992 showed that in Britain chiropractic was the second most frequently used complementary therapy. I emphasise that it is complementary, not alternative, therapy. It offers the patient an additional option of treatment for certain conditions by which they have been afflicted.
The cause that drives patients to a chiropractic is a pain which is almost impossible to describe. It is widespread, it is a misery and it can be utterly crippling. It is extremely difficult to cure back pain. It is like trying to cure a leak in a roof. Moreover, the victims of back pain suffer because it is not glamorous. Unlike a leg in plaster, one cannot see it. Back pain does not kill and it is not a terminal illness,

but it can be such hell that there have been recorded incidents of patients being driven to suicide through suffering pain.
I congratulate the Government on recognising the importance of back pain. Indeed, the White Paper "The Health of the Nation" stated that back pain had a strong claim for priority action. The successful treatment of back pain by chiropractors has been recorded. In 1989, a MORI poll showed that 93 per cent. of users were satisfied with their chiropractic treatment.
There is more to the treatment than simply relieving people of the miserable pain. Relieving people of that pain means that we can get them back to work. Days off work as a result of crippling back pain are astronomical. One can find all sorts of different estimates, but it is reckoned that 310,000 people are off work every day with some kind of back problem. If one uses a pocket calculator and multiplies those figures, we may conclude that millions of working days are lost annually through back pain. It has been estimated that the country has suffered a loss of more than £3 billion every year in lost production.
To put it another way, it is estimated that four out of five people experience back pain at some time in their lives. I shall add my mercifully short-lived experience—it lasted only 10 days. I have never known such pain. I was fortunate that it resolved itself, but I have an inkling of what other people go through.
The people most likely to be at risk from back pain tend to be athletes, who, by the nature of their activities, push their bodies hard; nurses, who have the task of lifting heavy patients; and housewives—I am proud to be a housewife on top of my other duties—who experience the hard work of lifting equipment in the house and heaving children on the hip, which is certainly not good for us.
We also drive ourselves to becoming victims of back pain through poor posture, by falling, by driving cars with badly designed seats in our car-crazed society and by sitting long hours in front of a computer terminal or a typewriter, which can cause spine, neck and shoulder problems. Severe problems may be caused by sciatica, arthritis and rheumatism. The hon. Member for Preston (Mrs. Wise) pointed out that those conditions do not respond well to rest and pain killers and we must use alternative help—hence the important role of chiropractic.
Complementary medicine is not new and some unlikely names have resorted to it. I can go no higher than Her Majesty the Queen, whose support for homeopathy is well known. His Royal Highness the Prince of Wales supports osteopaths, but the chiropractic profession is not to be outdone, because Her Royal Highness the Princess of Wales is its patron.
My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) described the work of the Anglo-European College of Chiropractic. That college has world recognition and has made a large contribution to research. It provides advice on how to avoid pain by standing correctly with evenly distributed bodyweight, how to ensure that our necks and backs are in straight lines—even as I speak, I am trying to practise what I preach—and how to sit straight in chairs with the base of the spine well-supported. Considering that we spend so many hours in the Chamber, I am glad to see that the green Benches are designed to give us more support, although it is sometimes a little hard. The college also advises car manufacturers on driving positions which avoid having to stretch the neck


and on car seats which support the lumbar regions, the spine and the thighs. It advises patients to sleep with one pillow only and always to have a good, hard mattress.
The wonderful news about chiropractic is that it has come in from the cold. For years, chiropractic treatment has been ostracised by conventional medicine, but attitudes have moved on. In 1986, the British Medical Association dismissed complementary medicine with olympian disdain, despite the fact that in 1981 the British Chiropractic Association approached the Medical Research Council to evaluate chiropractic for low back pain.

Mr. Elletson: I am sure that we were all interested in what my hon. Friend was saying about posture and I compliment her on her posture, which is especially elegant. I was very disturbed by what she had to say about the possible threats to her posture caused by the heavy equipment that she was accustomed to lift around her house in her capacity as a housewife, and I am sure that my hon. Friends and I would want to assure her that any time that she wants help to lift heavy equipment we would be delighted to oblige.

Lady Olga Maitland: I thank my hon. Friend for his kind offer and naturally I will take up his assistance any time—it is more likely to be in the House of Commons when lifting typewriters.
I shall return to discussing the valuable work conducted by the Medical Research Council in evaluating the efficacy of chiropractic. It studied 741 patients with back pain, who were randomly selected and allocated to chiropractors or to the usual hospital out-patient treatment centres in 11 localities across the country. The patients were asked to respond to a questionnaire about their pain and disability. The results showed that chiropractic was considerably more effective than orthodox hospital out-patient treatment. Patients said that they experienced
large benefits in relief of pain and increased activity.
That contributed to the improvement in the patient's quality of life. The MRC report said:
There may be substantial economic benefits arising from the introduction of chiropractic into the NHS.
Although that could add about £4 million at 1989 prices if it were extended in a full breadth, it should be pointed out that if it provided for
the 72,000 referrals per annum who would be suitable for chiropractic treatment…it would be offset by savings of around £13 million
a year
in lost output and £2·5 million in social security payments".
I trust that the Minister will tell us of his hopes to expand the availability of chiropractic treatment in the health service, although it has already been pointed out that GP fundholders take advantage of their budgets to send patients for chiropractic treatment. It could be that the passionate remarks made by the hon. Member for Preston about the lack of NHS treatment for her constituents are a result of the fact that in her constituency there are no GP fundholders. The reasons could be political rather than medical. A total saving to the country of nearly £16 million a year is worth making; hence there is a powerful case for chiropractic being medically and economically sound.
The success of the treatment is not lost on a whole range of people apart from the royal family. I can give the

example of a leading actress, Helena Bonham-Carter, who is a devotee of chiropractic after having been relieved of the back pain that plagued her in her early twenties.
The Medical Research Council, in the conclusion of its report, said:
The results of the trial leave little doubt that chiropractic is more effective than conventional hospital treatment.
It is gratifying that the British Medical Journal published a research paper which said that chiropractic works so well that it should be considered widely in the national health service. In a letter to The Times in July 1993, Dr. Fleur Fisher, the head of ethics, science and information at the British Medical Association, supported the regulation of complementary therapies and said:
There is no war against therapies that may indeed be complementary. Our report recommended that closer collaboration between the medical profession and practitioners of non-conventional medicine should be encouraged in research.
About two thirds of family health service authorities, general practice fundholders and district health authorities think that complementary medicine, and within that chiropractic, has a valued place.
I want to make a proud boast. One of the largest chiropratic practitioners in the country is in my constituency, in Sutton. The practice is headed by Dr. Brian Hammond in the Brighton road, in a building that is a familiar landmark to my local community. Out of 166,000 people in Sutton, the practice has now treated 16,000 patients; that is one in 11. The practice sees about 500 people a week, 65 per cent. of whom come to the practice directly as the first port of call and 35 per cent. of whom come as general practitioner referrals. Five years ago, the picture was quite different; in those days, 80 per cent. made their own way to the chiropractor and only 20 per cent. were referred by their GP. Ten years ago, the picture was even worse; about 95 per cent. had to use their initiative and make their way there, with five per cent. only being sent by their GP. It is remarkable to see the rapid acceleration and acceptance of the chiropratic profession within the health profession.
Dr. Hammond made his contribution to chiropractic medicine by selecting for his PhD thesis the examination of methods of identifying people who might develop back pain in the future. In other words, he was looking at preventative medicine. Time prevents me from discussing that further, but it must be said that Dr. Hammond is a key figure in this field. I believe that he is one of the examiners at the college in Bournemouth.
It is significant that, although chiropractic treatment is largely paid for by patients, it should be taken on board that the cost is manageable. Certainly, in Sutton, patients pay on average about £20-plus—I have to say that the plus is for value added tax. Herein lies the rub. Practitioners are treated as small business men and are therefore required to pay VAT on the services that they offer, which puts up the price. There is welcome news in that, once the statutory register is open, I understand that Customs and Excise will recognise chiropractic practitioners as health professionals and therefore VAT need not be charged. That means that chiropractors will catch up with dietitians, chiropodists, occupational therapists, orthoptists, physiotherapists and radiographers.
Dr. Hammond, in common with all his colleagues, is delighted that the regulation of chiropractic as a profession will outlaw rogue practitioners. He wants to see the highest standards maintained because he is deeply aware of the dangers of rogue quacks, which are fairly obvious.
Patients put their trust in chiropractors and, as my hon. Friend the Member for Beckenham (Mr. Merchant) described so vividly, that trust can be totally abused. With chiropractors having no recognised training and simply putting up name plates, they can abuse that confidence and dangerously mis-diagnose patients. They could overlook a serious condition and, indeed, fail to send patients to a GP. It has already been recognised that severe back pain can often mask other serious conditions, even cancer.
Proper and conscientious chiropractors with six years of training behind them carry out their work in a detailed and careful way. They carry out many tests, including X-rays and blood and urine tests, which quickly identify any serious medical mischief that needs to be tended to. However, it is unlikely that practitioners with only brass name plates to their names will go to that trouble.
The Bill is especially welcome. As the report of the King's Fund recognised, the demand for the services of chiropractors is set to double over the next five years. I congratulate Sir Thomas Bingham, who is now Master of the Rolls, on chairing such a distinguished team. I also welcome the presence in the Gallery today of Mr. Simon Fielding, who is an observer—

Mr. Deputy Speaker: Order. The hon. Lady must not refer to people in the Gallery.

Lady Olga Maitland: I stand corrected. I am delighted that those who are observing the proceedings today will see that their own work has been fully recognised. Chiropractic will now catch up and be statutorily regulated, as it is in 17 countries, including most of Europe. It is entirely appropriate that Great Britain and Northern Ireland, which were almost alone among English-speaking countries in not recognising chiropractic, are now following other countries. I wish my hon. Friend the Member for Aylesbury every good speed in piloting the Bill though its remaining stages.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): I start by adding my congratulations to my hon. Friend the Member for Aylesbury (Mr. Lidington) on both his success in the ballot and his excellent choice of Bill. May I say straight away that the Government fully support the Bill and hope that it will receive the support of the House.
Chiropractic is an important topic because it would appear that almost since the birth of time physicians have used manipulative techniques in the treatment of patients. The earliest recordings are contained in Chinese writings dating back to 2700 BC. Hippocrates and Galen both wrote on the benefits of manipulating the spine. Throughout medieval times and into living memory, local "boneset-ters", as they were sometimes called, practised techniques that were to become the early precursors of modern chiropractic and osteopathy.
Chiropractic was developed in the United States in the latter years of the last century. The first person to benefit from chiropractic treatment as we know it today was said to be Harvey Lillard, who had become deaf following an injury to his spine. On 18 September 1895, his spine was manipulated by Daniel David Palmer, the father of modern chiropractic, and his hearing was restored. I trust that my

hon. Friend's Bill will be successful in reaching the statute book in time for the profession's centenary celebrations next year.
Chiropractic arrived in Britain in the early years of this century. In 1925, the first voluntary professional association for chiropractors, the British Chiropractic Association, was founded. It was not until 1965, however, that, after several unsuccessful attempts to set up training institutions in this country, the first permanent school, the Anglo-European College of Chiropractic, which is now in Bournemouth and to which several hon. Members have referred, was established. Prior to that, chiropractors wishing to practise or to learn generally had to travel to the United States to receive formal training. In 1988, the college's degree course was validated and approved by the Council for National Academic Awards, becoming the first degree course in complementary medicine to be recognised in this country.
For many years, the Anglo-European college provided the only training in chiropractic in the United Kingdom. In 1972, however, in response to popular demand, John McTimoney, a former jeweller and silversmith who had benefited from chiropractic treatment, opened a school in Oxford. Although he received his training from a graduate of the original Palmer school, Dr. Mary Walker, he developed a technique that differed from those being taught and used by other chiropractors at that time.
In 1984, a further school, the Witney School of Chiropractic, was founded in Oxford by Hugh Corley. He had trained at the McTimoney school under McTimoney, under whose guidance he went on to refine and develop a further variation of manipulation, now known as the McTimoney-Corley technique. Both the McTimoney and Witney schools are working towards securing validation of their respective courses. Holders of diplomas from those schools also participate in systems of voluntary registration. McTimoney chiropractors are registered with the Institute of Pure Chiropractic and McTimoney-Corley chiropractors belong to the British Association of Applied Chiropractic.
The profession has continued to grow and develop. There are now more than 900 chiropractors working in the United Kingdom, twice the number who were practicing five years ago, with the number of practitioners likely to double again before the next centur. It is estimated that about 75,000 men and women each week from all walks of life and across a wide section of the population consult a chiropractor. That figure is perhaps three times higher than the figure given by my hon. Friend the Member for Blackpool, North (Mr. Elletson) in his otherwise accurate and interesting speech.
That makes chiropractic the most widely used complementary therapy after osteopathy. I now declare an interest, in that I am a long-term sufferer of back pain. There have been a number of attempts to sort me out over the years, and I remember when I was about eight it was decided that one of my legs was shorter than the other. I was given built-up shoes, which gave me nothing except an inferiority complex.
I discovered the chiropractic profession through my good friend Stanley Grundy at the National Back Pain Association, who arranged for me to travel to Sutton to be treated at the excellent practice which was referred to by my hon. Friend the Member for Sutton and Cheam (Lady


Olga Maitland). I failed to ask my hon. Friend's permission or approval before I made what was a partly medical, partly ministerial visit to her constituency, and I apologise.
The visit was worthwhile because it gave me an insight into the subtlety and the efficacy of chiropractic, and into the excellence of the profession. Most people like me consult a chiropractor because of lower back pain, but, as has been said, chiropractic treatment can be also used to treat head injuries, neck and upper body pain, rheumatism and sports injuries.
In 1990 the British Medical Journal published the results of the first clinical trials of chiropractic in this country. The trials compared chiropractic treatment with hospital out-patient management of lower pain back in 741 patients across 11 centres. As the hon. Member for Preston (Mrs. Wise) pointed out, the results showed that only one hospital department appeared to get better results than chiropractic. Improvements persisted over time, and chiropractic patients also benefited from a reduced chance of needing further treatment.
I am not aware of another discipline within complementary medicine which has taken the bold step of allowing its practice and treatment skills to be tested in this way against mainstream medicine. In 1990, a poll conducted by The Times and MORI suggested that 93 per cent. of those consulting a chiropractor were satisfied with the treatment they had received, and I would include myself in that.
The value of such treatment has also been recognised within industry. It is perhaps not widely known that the Taunton Cider Company has, for the past 10 years, engaged chiropractors to treat its work force. Similarly, the Saccenda factory in Northamptonshire took part in a small pilot project to provide chiropractic treatment for its employees.
Those employers, as well as others such as St. Ivel, British Cellophane and the South West electricity board, believe that making chiropractic treatment available to their work forces clearly provides a cost-effective way of ameliorating the effects of industrial injuries, and reduces the time and the production lost through sickness. Many would say that that also reflects good industrial relations, and makes an important contribution towards meeting "The Health of the Nation" targets by improving the overall health of the work force.
Chiropractic has similarly continued to grow in stature in the eyes of the medical profession. Lord Walton said in another place:
Some 20 to 25 years ago it was regarded as improper for a doctor to associate with complementary practitioners".—[Official Report, House of Lords, 31 January 1992; Vol. 534, c. 1593.]
He went on to say that at that time a doctor referring a patient to a non-medically qualified practitioner would have fallen foul of the recommendations of the General Medical Council on professional conduct and discipline.
Today, however, the medical profession regards chiropractic as complementary to the treatment provided by medical practitioners and a treatment that enhances the range of possible treatments available to patients. Cross-referrals between GPs and chiropractors are becoming more common. These days it would not be unusual for a chiropractor to treat a patient who is concurrently receiving medication from his or her general practitioner.
As many will know, "chiropractic" literally means "treatment by hand". It involves assesing the patient's condition and making a manipulation or adjustment to correct it. Chiropractors will not provide treatment where there are signs of other complications such as inflammatory disease, infection or indications of a tumour in the spine. In the same way, chiropractors will not use some of the more vigorous techniques if there is evidence of osteoporosis, damage to ligaments or recent fractures to bones. Chiropractors also take particular care if the patient has a history of circulatory problems, including aneurisms.
Before commencing treatment, a chiropractor will take a detailed life history from the patient, making observations on such matters as lifestyle, posture and gait. Some chiropractors may also make use of X-rays, but the principal assessment and treatment tool for all chiroprac-tors is their hands. Should the chiropractor come across something that suggests that chiropractic treatment would be inappropriate, or discovers evidence of a more serious underlying health problem, he or she will refer the patient to a medical practitioner.
Once all the stages that I have described have been completed, treatment may begin. Within the range available to a chiropractor are such techniques as mobilisation, which involves moving joints to their full extent, manipulation or adjustments that return misplaced or badly aligned joints to their correct position. Those techniques all require absolute precision and the highest level of skill.
As my hon. Friend the Member for Aylesbury has said and other hon. Members have reiterated, at present anyone can call himself or herself a chiropractor and set up in practice. There is no obligation for practitioners to undergo any formal training or to comply with any standards of professional competence or ethical practice. Although the current voluntary regulation schemes have been well supported and, to their credit, reasonably successful, they cannot enforce standards of competence or conduct because at the end of the day a practitioner can simply decide to opt out of membership.
Therefore, the public have no guarantee that people calling themselves chiropractors are properly qualified or competent in either the practice of chiropractic or the skills of differential diagnosis, which is knowing when chiropractic treatment is inappropriate and medical attention is more properly and perhaps more urgently required. My hon. Friend's Bill will enable such doubts to be eradicated.
The Bill is the first to be introduced with the aim of securing statutory regulation for the chiropractic professsion. Statutory regulation is a goal for which the profession has been striving for some years. In the past, however, such efforts have been pursued in a somewhat piecemeal fashion by one part or other of the profession acting independently. For example, in 1975 the British Chiropractic Association applied unsuccessfully to be included as one of the professions regulated under the Professions Supplementary to Medicine Act 1960. It would therefore be fair to say that chiropractors, as represented by the present association, have not always seen eye to eye on the way forward for the profession.
A significant breakthrough occurred in 1991, when representatives from all the chiropractic associations came together to form the chiropractic registration steering group. That organisation, which is now a limited company,


represents the unified voice of the chiropractic profession and exists for the single purpose of paving the way for the statutory regulation of the profession.
The profession can be justly proud of the chiropractic registration steering group and its achievements. Many people would agree that the profession would not be where it is today if it were not for the determination and commitment of members of the group. It has moved rapidly and with authority to achieve consensus within the profession. Education and training is the most significant area in which it has made inroads. It has agreed that, within five years of legislation regulating the profession coming into force, all chiropractic education and training institutions in the United Kingdom represented by members of the steering group will have levelled-up standards, for the benefit of patients and the profession alike. That is not to say that chiropractors registered within one of the registering bodies are not properly trained, but is an acknowledgement of the fact that the profession has developed in the United Kingdom along distinct and separate lines and that it now wishes to pull together in the same direction.
Nor does the agreement mean that the McTimoney and McTimoney-Corley schools will lose their individualism. The Bill is not an attempt to dictate the curricula to be taught. Diversity of approach stimulates innovation. For instance, medical schools differ considerably in their emphasis over elements of the curriculum and the way in which they are taught, but they all produce safe and competent doctors. It is therefore essential that the diversity that already exists within the chiropractic profession continues to flourish under the proposed statutory scheme.
I underscore the importance of the chiropractic profession continuing to build on and exploit the unity that it has achieved through the steering group. My hon. Friend's Bill is the means that could cement that unity and lead the profession on into the future. I therefore take this opportunity to urge all chiropractors to support the contribution that their organisation is making to the work of the steering group.
The Bill will preserve patients' freedom to choose the type of chiropractor they consult, while meeting the concerns that the profession rightly has to ensure that there are adequate safeguards. Under the terms of the Bill a single statutory body, the General Chiropractic Council, will be established to develop, promote and regulate the chiropractic profession and set standards for educational and professional competence. The general council will be the vanguard of the profession and will play a key role, especially during the scheme's formative years, to help to raise the profile of chiropractic as it is practised in all its various forms in the United Kingdom.
As my hon. Friend the Member for Aylesbury said, the initial chiropractic members of the general council will be appointed by the Privy Council, after consultation with those organisations that administer the present voluntary registration schemes.
I understand that when the King' Fund working party made recommendations on membership of the first general council, consideration was given to granting each of the existing voluntary registration groups a proportion of the seats on a pro-rata basis.
The working party's final recommendation, however, was that the Privy Council should appoint the first chiropractic members after consulting with those bodies

that operate the voluntary registration schemes, not as representatives of a particular organisation but on the basis of their individual ability and merit. Those members will, therefore, be selected to represent the different branches of chiropractic in the United Kingdom and for their ability to help to secure the highest standards of clinical practice and bring out the very best ideas from all quarters of the profession.
That members will be neither delegates or representatives of a particular organisation nor beholden to any sectoral interests will be of key interest in enabling the profession to move forward to the next stage of its history. So it is worth making the point again that members will be selected on the basis of their individual ability and merit to be ambassadors for the whole profession.
At about this time last year, the House had the privilege to debate a Bill introduced by my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). His Bill successfully went on to complete all its stages and became the Osteopaths Act 1993. It has provided a model not only for the chiropractic profession but for all the professions of non-conventional medicine to follow. I had the honour, as did the Opposition spokesman, the hon. Member for Bristol, South (Ms Primarolo), to contribute to the debate and support that Bill. It builds on the stepping stones to statutory regulation described in 1985 by my noble Friend Lord Glenarthur, the then Under-Secretary of State in what was in those days the Department of Health and Social Security. Those set out the criteria which the Government expected professions of non-conventional medicine to fulfil before they could be considered for statutory regulation.
The same principles apply today and it may help the House and my hon. Friend the Member for Bournemouth, East (Mr. Atkinson), who asked about complementary medicine in general, if I set out those principles this afternoon. First, the therapy should be founded on a systematic body of knowledge. Secondly, there should be in place a recognised system of voluntary registration that embraces an appropriate and enforceable code of conduct. Thirdly, the move to statutory regulation should be supported by members of the profession—I have already touched on the need for unity within the chiropractic profession. Fourthly, the profession should secure the support and acceptance of the medical profession. Finally, the profession should go on to test the will of Parliament by means of legislation.
Like the osteopathic profession, the chiropractic profession has been working at and meeting those criteria for a number of years. In December 1991, the chiropractic profession trod the pathway laid by osteopathy by securing the agreement of the King's Fund to set up a working party on chiropractic to consider the case for statutory regulation. Like the working party on osteopathy, that working party was chaired by the right hon. Sir Thomas Bingham, Master of the Rolls. The working party published its report in May last year and recommended the establishment of a statutory scheme that mirrored the provisions of the Osteopaths Act.
I should like to express the Government's thanks to the working party, the right hon. Sir Thomas Bingham and other members, and to the King's Fund. Without doubt they made a significant and central contribution to the chiropractor's pursuit of statutory regulation.
Having satisfied the criteria that I have described, the Government believe that the most suitable way for a


profession to pursue its quest for statutory regulation is by way of a private Member's Bill. I know that some hon. Members hold the view that a Bill as detailed and complex as this one should be a Government Bill. I assure the House that, as with the Osteopaths Bill, we gave this matter careful consideration. The fears of some hon. Members about supporting a private Member's Bill of such length and complexity as that of the one for osteopaths proved to be unfounded. I hope that such fears in connection with this Bill will also be unfounded.
We concurred with the view, held over many years by successive Ministers, that professional regulation, particularly the regulation of a non-orthodox medical profession, should be pursued by the private Member's route. That frees Parliament from traditional party influences, allowing it to make up its own mind on this important issue according to the merits of the case. As I have said, the shining example of the Osteopaths Act clearly demonstrates that that approach can be successful. I hope that my hon. Friend's Bill will build on that example and will give further encouragement to those practitioners in complementary medicine who wish to pursue this aim.
I shall now deal briefly with the contents of the Bill. My hon. Friend the Member for Aylesbury has outlined its purpose and content and its major provisions. The regulatory system proposed for chiropractors is, of course, closely modelled on those that exist for other major professions, including all the key health care professions. In particular, it follows the pattern of statutory regulation enshrined in the Osteopaths Act, reinforcing that as the model for other groups.
In common with the Osteopaths Act, my hon. Friend's Bill explicitly designates professional incompetence as a basis for disciplinary investigation. I know that other professions have been encouraged to investigate ways and means of introducing that concept for their members. The solutions reached may be different from the different professions, but osteopaths and chiropractors can take pride in the fact that they propose to include this provision from the outset of their statutory scheme for the benefit of their patients.
Similarly, the Bill contains a provision for the future introduction of compulsory refresher training as a condition of continuing registration. That is in line with current thinking in a number of health care professions, and follows the precedent set in the Osteopaths Act. That provision will help to reassure the public that the practitioners whom they consult are keeping up to date with knowledge and developments in their fields.
Perhaps one of the most important elements of the Bill is its provision to protect the title "chiropractor" or any variations of the term, and to make it a criminal offence for other than a registered practitioner to call himself by that name. I know that that provision interests many related professions. I confirm that it is not intended to prevent other professionals such as physiotherapists from using chiropractic techniques in the course of their practice or from telling their patients that they are using such techniques. The offence provides specifically for closure of title, not closure of function. I hope that my remarks will reassure those who are concerned about that. Other professions are anxious to secure closure of their professional title. Our advice to them is to follow the

examples of osteopaths and chiropractors and to seek that goal through private Member's legislation. I see, for example, that podiatrists have followed that advice and are seeking to secure closure of their title through the Bill that was introduced by the right hon. Member for Manchester, Wythenshawe (Mr. Morris).
As careful readers of the Bill will have noted, it also contains a panoply of appeal rights—for example, at various stages of the proposed fitness-to-practise procedures—against a decision of the general council to remove a name from the register that has been fraudulently or incorrectly made, and as part of the registration process. The Government's view is that those are desirable and necessary to fulfil our human rights obligations. The Bill also reflects our European obligations in respect of the recognition of professional qualifications.
As my hon. Friend the Member for Aylesbury has already remarked, added protection for the public is provided through the exemption of registered chiropractors from the Rehabilitation of Offenders Act 1974. That will bring chiropractors into line with other health care professionals and will mean that applicants for registration will, if asked, be required to declare all their criminal convictions, including spent convictions. The General Chiropractic Council will also have the power, through rules approved by the Privy Council, to ensure that practising chiropractors hold professional indemnity insurance. The scope of these rule-making powers will be sufficiently wide to enable the general council to check that that requirement is being complied with and initiate disciplinary proceedings against a practitioner where it is not.
There is nothing in the Bill to affect the rights of members of the public to consult chiropractors direct, nor chiropractors' professional freedom to treat their patients. With all its statutory powers, the General Chiropractic Council will not be able to interfere with the free market that currently exists in terms of the scale of fees that chiropractors may charge. As my hon. Friend has already remarked, should the need ever arise, powers of intervention are provided against any anti-competitive practices that the general council might contemplate. My hon. Friend has already drawn attention to the fact that it is anticipated that the Bill will have only minor implications for public expenditure, which would arise only in the unlikely event of the Privy Council having to exercise its default powers over the General Chiropractic Council. I can confirm that assessment from the Government's viewpoint.
The House will be reassured to know that on no known occasion has the Privy Council had to exercise similarly held powers in respect of other statutory schemes. I am sure that the chiropractic profession has no desire to achieve a first in that respect. The passage of the Bill is not in any way related to the availability or otherwise of chiropractic on the NHS. Having heard of the many benefits that chiropractic can offer, I suspect that many people—as we have heard from some hon. Members today—may feel that the treatment should be provided more widely on the NHS. 
The simple fact is that chiropractic can already be obtained on the NHS. The hon. Member for Rochdale (Ms Lynne) said that she felt that nothing in the Bill widened that availability. She is mistaken. One of the principal effects of the closure of title and the regulation of the chiropractic profession is precisely to give medical


practitioners and the public greater confidence that, when referred to a chiropractor for treatment, they will go to a professional person who has the backing of a statutory body, has the necessary training and, perhaps more importantly, is subject to the disciplinary proceedings that that body may bring against that practitioner if there is any form of indiscipline or abuse.
That is an important point. Many members of the medical profession take a deeply conservative view of medical treatments, as is demonstrated by the contrast between the rates of introduction of new pharmaceutical products here and in other parts of Europe. Many of those people will need the reassurance of knowing that, if they refer patients, they can be certain that they are referring them to practitioners who will be thoroughly competent and held to account for their actions.
I hope that I have gone some way to convincing the hon. Lady that the Bill takes a major step forward in making chiropractic more generally available on the NHS. That will require the co-operation of the medical profession and, indeed, of NHS managers.
As I said, chiropractic can be obtained on the NHS. General practice fundholders can use the staff element of their budgets to employ chiropractors; non-fundholders may also employ them, although many will do so only if their local family health service authorities can reimburse the costs of the therapists' salaries from their cash-limited funds for GP staff and premises. The message is, however, that it is up to any GP fundholder or district health authority to conclude that the treatment should be made available to patients. The Bill will make many of them much more confident about referring patients.
In the hospital sector and elsewhere in the NHS, the only constraint on the provision of chiropractic—or any other service deemed to be of benefit to patients—is the requirement for the local health authority to consider its provision necessary to meet the reasonable demands of the public. Chiropractic is therefore no different from any other forms of treatment. It is up to the profession to convince those who make decisions—whether they are health service managers or practitioners and others in the medical world—that chiropractic will indeed be of value to patients. Whether it should be commissioned is a matter for local decision making, and must remain so; people will have to assess locally the extent to which it is beneficial.
Audit studies are already being carried out in several parts of the country by district health authorities such as the Dorset, Bath and Wiltshire health commissions. I do not know the reason for the concentration on the south-west; others may be able to enlighten me. I note that there seems to be a concentration of hon. Members from that area in the Chamber today. The commissions are examining the feasibility of purchasing chiropractic for their local populations.
This country has only about 900 chiropractors. If the greater part of the NHS considered purchasing chiroprac-tic, initially there would not be enough practitioners to go round; if the Bill succeeds, however—as I hope it will—there is every likelihood that statutory regulations will have the additional effect of stimulating the continued growth of the profession, and spurring on many more people to consider chiropractic as a career. Statutory regulation can also be expected to encourage closer working relationships between doctors and the profession.
I am sure that the House will forgive me if I briefly mention the general subject of alternative and complement-tary medicine, and especially the benefits to the NHS that many of its supporters—we have several in the House today—believe that it could bring. I appreciate that this is a subject on which people hold strong views which arise from a genuine concern that NHS patients should receive the very best treatment. One of the criticisms often levelled at orthodox medicine is that it fails to recognise the individuality of the patient and instead focuses on his or her particular problems in a somewhat impersonal way. There may be some important lessons to learn here about the way in which patients wish to be treated.
Some take the rather extreme view that orthodox medicine all too often resorts simply to pumping patients full of drugs or to lopping off those bits that no longer function properly. Many supporters of alternative and complementary medicine feel that there is another and better way in which to approach sickness and illness. They believe that if the range and availability of such treatments on the NHS were increased, the NHS would save money on the ever-spiralling cost of drugs and prescriptions, the need for unnecessary surgery and other invasive procedures would be reduced and there would be an improvement in the overall quality of life for patients. Those are laudable intentions.
Research suggests that people consult alternative and complementary practitioners in addition to receiving orthodox treatment on the NHS. We are keen to explore the question and to find out whether alternative and complementary medicine available in one part of the NHS impacts on other parts and, if so, in what ways. We have, therefore, commissioned the medical care research unit at Sheffield university to carry out research into the impact within general practice that complementary therapists such as osteopaths, chiropractors, acupuncturists and herbalists have on hospital referrals, prescribing and drug costs and patient satisfaction. The project began last December and will take two years to complete.
I hope that I have established to a small degree our credentials on alternative medicine. One of my parents was once president of the General Council and Register of Osteopaths and the other ran the homeopathic hospital in Tunbridge Wells, so I am not entirely divorced from these matters despite being connected with the Department of Health.
How are the Government able to support the chiropractors' quest for statutory regulation when we are pursuing deregulation elsewhere? The aim of the Government's deregulation initiative is to reduce the burden of existing regulations and to ensure that unnecessary new regulation is avoided. Our aim is to deliver better goal-based regulation in proportion to the risk involved, especially where there is a need to protect members of the public. The Bill is not an attempt, as my hon. Friend the Member for Aylesbury assured us, to impose a heavy-handed regulation that dictates everything from the size of the treatment table to the content of the practitioners' training. Instead, it is about entrusting to the professionals the means to regulate more effectively and enabling them, within a statutory framework, to chart their own destiny. The Bill will also provide adequate assurances to the public about the education, training and competence of chiropractors.
In the past two years, two groups of alternative complementary medical practitioners have sought statut-ory regulation. That may conjure up in the minds of hon. Members a picture of a queue of those professions standing in the wings, waiting for their turn on the parliamentary stage. Although I have no crystal ball in which to gaze, I suspect that it may be some time before the next profession is in a position to pursue similar legislation. That does not mean that other health care professions may not consider modernising their statutory schemes, but I do not foresee a completely new group coming into view on the horizon, possibly for some years to come.
That raises the question whether the Government should be considering statutorily regulating other groups. I know that that is the view held by some hon. Members, including, I believe, my hon. Friend the Member for Bournemouth, East. We believe that, in the context of the health care professions, statutory regulation should not impose restrictions but provide freedoms. For example, the osteopathic profession can regard having achieved statutory regulation as a prize or reward for a job well done. It is something for which it has striven for more than 60 years, and it builds on a very successful system of voluntary registration and regulation.

Mr. David Atkinson: I hear what my hon. Friend says, but does he agree that after 30 years the Professions Supplementary to Medicine Act 1960 deserves a review, especially in view of the concerns being expressed by physiotherapists to which I referred earlier?

Mr. Sackville: I believe that it would be most appropriate for professions to consider private Members' legislation, such as that which we are discussing today, as a means of achieving protection of title, if that is what they wish. My hon. Friend will remember that that was the case with the Bill relating to podiatrists which was introduced by the right hon. Member for Wythenshawe. Any review of the Professions Supplementary to Medicine Act 1960 would raise many wider issues and could be undertaken sensibly only in the light of a thorough evaluation of how it would fit in with the Government's health service reforms and the effects of changes in community care.
As I said, osteopaths are now statutorily regulated, not because they are hot-headed individuals who are wielding a dangerous or violent form of treatment that needs to be controlled, but merely in order to enable them to regulate and develop their profession more effectively. Such a framework will provide safeguards for the public by assuring continuity in the quality and standard of treatment that they can expect to receive.
Statutory registration, based on the principle that an individual practitioner has demonstrated that he or she has undergone acceptable courses of straining and achieved the required standard of competence, provides that assurance. It also provides an effective system of redress in the event that something goes wrong. As I said to the hon. Member for Rochdale, they are two vital contributions to building the confidence of the medical profession and the public in a profession or form of treatment which has up to now been considered to be outside the mainstream of the medical profession.
In that context, we therefore view statutory regulation as the logical next step to a system of voluntary registration

supported by the majority of practitioners of any particular profession. It is precisely for the reasons that I have just described that chiropractors wish to follow the osteopaths and secure statutory regulation for the profession.
Imposing statutory regulation on a profession that neither desires it nor is capable of administering it would be unwieldy, expensive and difficult to police. It would also take away from the profession the right and ability to control its own destiny. Such a situation is clearly far removed from the system of statutory regulation enshrined in the Osetopaths Act 1993 and in the Bill introduced by my hon. Friend the Member for Aylesbury. Those measures are founded firmly on the principles of professional self-regulation.
We believe that a system which embraces high standards of education, of training and of clinical practice, alongside the development of an enforceable code of practice that provides proper safeguards for patients, is the hallmark of a responsible profession. We have therefore welcomed the progress which many of the alternative and complementary professions have made along the path of voluntary self-regulation, but we remain firmly of the opinion that the question of statutory regulation must remain one for the professions themselves to consider whether to pursue.
The examples of the osteopaths and the chiropractors may lead other groups to consider the question afresh and perhaps with greater urgency. I also suggest that if purchasers of health care services, such as district health authorities and GP fundholders, take the view that to be assured of the quality of service that they are buying they would purchase alternative and complementary therapies only from those groups which are statutorily regulated, it would add further impetus for such groups to consider the matter.
My hon. Friend the Member for Aylesbury has already said that his Bill contains a handful of fine-tuning amendments of the Osteopaths Act. That Act was a mould-breaking piece of legislation and introduced a number of innovatory ideas for the regulation of health care professions. The powers of the fitness-to-practise committees, for example, to take immediate action to protect members of the public are perhaps the most comprehensive in any statutory scheme. The Chiropractors Bill, which effectively reproduces the provisions of the Osteopaths Act, has provided an almost unprecedented opportunity to reconsider the detail underpinning both the statutory schemes.
I am sure that many hon. Members who have sponsored private Members' Bills would have welcomed the opportunity to twiddle with their piece of legislation once it had reached the statute book. Some hon. Members may well think that probably a number of Ministers would also welcome such an opportunity. Whatever they may think, all I can say is that I cannot possibly comment. It is a tribute to the robustness of the Osteopaths Act and to my hon. Friend the Member for Cambridgeshire, North-East that there are so few amendments to be made, many of which are simple, drafting amendments to fine-tune the scheme and to make a first class piece of legislation even better.
May I conclude—[HON. MEMBERS: "Hear, hear!"]—by reminding the House of what the Bill is all about. It is principally about the back pain that many people suffer all over the world, but is probably aggravated by the way in which many of us sit around—[HON. MEMBERS: "Hear,


hear!"]—like today, and remain for long periods in a sedentary position. For that reason, an increasing number of people in the country would probably benefit from an enlargement and a development of the profession of chiropractic.
I therefore strongly commend my hon. Friend's Bill to the House, and I commend all his supporters and sponsors who are here to cheer him on today. I sincerely believe that the Bill's provisions will apply to all members of the profession in a way which is valuable to them.
The provisions embrace chiropractic in the different forms in which it is practised today. Indeed, my hon. Friend's Bill is a very British solution to a very British problem.
Although the general council's responsibilities on the regulation, development and promotion of the profession will gradually subsume many of the functions of the voluntary registration systems, the variety of techniques and styles that constitute chiropractic in the United Kingdom can continue to flourish within an overall regulatory framework. That will enable today's patients and the generations of patients to come to choose the form of chiropractic treatment best suited to their individual and particular needs, in the certain knowledge that they will receive the greatest and highest quality of care from appropriately trained practitioners. For those reasons, I congratulate my hon. Friend on his Bill and warmly commend it to the House.

Ms Dawn Primarolo: As the Bill has all-party support, I think that it was unnecessary for the Minister to read his speech twice. I congratulate the hon. Member for Aylesbury (Mr. Lidington) on the Bill and on his comprehensive explanation of the clauses. Indeed, I felt at times that I was experiencing déjà vu, and when I checked Hansard, I found that I was hearing again the debate on the then Osteopaths Bill. Lessons were learnt in debates in the Committee of that Bill and I commend the hon. Member for Aylesbury for taking those arguments on board.
The Bill is about the regulation of a therapy and treatment that is being used by hundreds of thousands of people. The efficacy of that treatment is clearly demonstrated and the Bill proposes to include regulations for the protection not only of the public, so that they can be sure that they are consulting someone who is properly qualified, but of chiropractors.
There has been much discussion about the availability on the national health service of what are commonly called complementary therapies. We should put aside the idea that the medicine offered in the national health service is all conventional or orthodox and is the only type of medicine that works and is acceptable. They are complementary therapies that should be part of the NHS because they work; they are appropriate treatments, and the NHS is about offering to the public a comprehensive service of medical treatment that is free at the point of need. The surveys mentioned have shown that 70 per cent. of family health service authorities and 65 per cent. of district health authorities are in favour of all the complementary therapy services being made available freely at the point of contact. That is entirely different from referral on contact.
The national health service should offer such services. More than 900 practitioners give 75,000 consultations a week, and 310,000 people in the United Kingdom are off work each day because of lower back pain. The complaint costs the country more than £3 billion in lost production every year. In addition, there is the cost to the health service of providing treatments that are sometimes inappropriate and often expensive and that often cause unnecessary and undesirable side effects.
Disability from lower back pain in Britain is increasing faster than any other form of disability—the incidence has doubled in the past 10 years. Today's debate is not just about regulation, important though that is, but about what is available on the national health service and whether it is free and not subject to contract exchanges.
The British Medical Association has made its position clear. It states:
It is difficult at present for individuals to be certain that the therapist whom they are consulting is competent to practise. Similarly, it is not easy for doctors to ensure that the therapists to whom they transfer care of patients are competent. The present situation, in which anyone is free to practise, irrespective of their training or experience, is unacceptable. Where individuals undergo courses of training designed to equip them for the practice of particular therapies, these should conform to minimum standards appropriate to the responsibilities and demands of that therapy.
The Bill is an attempt to introduce such provisions into chiropractic.
Unfortunately, the Bill does not make such provisions freely available within the national health service. The Government are silent on the provision of money for the training of chiropractors and the Bill does not make that money available. If one wishes to be a chiropractor, one has to become one at one's own expense. The Bill is silent, and the Government have been silent, on the further research needed to ensure that the practice is available within the national health service. The Bill is silent on the need to ensure that we understand the potential of chiropractors in the NHS at both primary and secondary level.
The Labour party has consulted widely on making complementary therapies available in the NHS. The Royal College of General Practitioners welcomed our report and said:
A wide choice of therapeutic approaches is a necessary part of good practice,
and therefore should be available inside the national health service. My hon. Friend the Member for Preston (Mrs. Wise) referred to her experiences with a complementary therapist—a chiropractor. She mentioned, as have many other hon. Members, the involvement and partnership between patient and therapist—a relationship that should exist in all forms of medicine. Unfortunately, it does not always do so. The NHS could be greatly strengthened by the integration at all levels of complementary therapies available as part of a comprehensive health system.
The Bill is widely supported and will pass into Committee. A number of hours have already been spent debating it and all who have spoken have been in favour of its proposals. I sincerely hope that the House will accept the Bill and proceed swiftly to ensure its passage. I hope that it quickly returns to the Floor of the House to be given our final approval before gaining Royal Assent.

Mr. Toby Jessel: Mr. Deputy Speaker—

Mrs. Wise: On a point of order, Mr. Deputy Speaker. The hon. Gentleman has not been in the Chamber and the Bill has received whole-hearted support from all quarters. I feel that his speech will do a disservice to the Bill and prevent the Second Reading debate on the Nursery Education (Assessment of Need) Bill from starting.

Mr. Deputy Speaker (Mr. Michael Morris): That is not a matter for the Chair.

Mr. Jessel: I greatly resent that point of order. This morning, I attended the funeral of someone who did a lot of good work for people in my constituency. I wrote to notify Madam Speaker that I intended to seek to catch your eye, Mr. Deputy Speaker. I mentioned the funeral, and that I had a particular interest in this matter not only because I have been a patient of a chiropractor for many years but because the national headquarters of the National Back Pain Association is at Teddington in my constituency. I have raised the subject of back pain, which is linked with the question of chiropractic, in the House on many occasions.
In view of that constituency interest, it is entirely proper for me to seek to catch your eye, Mr. Deputy Speaker, and disregard the strictures of the hon. Member for Preston (Mrs. Wise), who perhaps was not aware of all that, but who should have found out before she jumped in as she did. To say that in some sense what I am about to say will detract from the Bill merely because I did not have the privilege, which I would have liked, of being present throughout the debate is to anticipate that I might attack the Bill, which I will not seek in any way to do.
The Bill has my warm support. I most strongly congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on having introduced it. I am sure that it will do good and I hope that it will have a smooth passage through the House, as the Osteopaths Bill did last year. I only regret that I did not hear my hon. Friend's speech or that of my hon. Friend the Minister, to whom I apologise for not having arrived earlier.
The chiropractor to whom I go is in Sutton—my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) has just left the Chamber, but I know that she spoke earlier. My chiropractor is Dr. Brian Hammond. He is a fine chiropractor to whom I was introduced by the National Back Pain Association and its founder, Mr. Stanley Grundy CBE, who is well known to my hon. Friend the Minister. Mr. Grundy founded the National Back Pain Association over 20 years ago. That association has done a great deal to promote research and to focus attention on back pain and the work of chiropractic and related professions. My hon. Friend the Minister was kind enough to visit the headquarters of the association at Teddington. I know that, like me, he suffers from back pain.
The hon. Member for Bristol, South (Ms Primarolo) was absolutely right when she drew the attention of hon. Members to the fact that every working day 310,000 people are off work because of back pain and that the cost to the nation is about £3 billion a year. About 60 million working days are lost a year. That is an enormous loss of days. Indeed, it is greater than the number of days lost

through strikes—not merely nowadays when there are hardly any strikes, but at the peak of striking, such as in the winter of discontent in the late 1970s when people seemed to go on strike every time the bell struck. An immense number of days were lost through strikes but it was no greater than the number of days lost through back pain.
Back pain is a major social evil which afflicts large numbers of people, but unfortunately it is not a glamour cause from a charitable point of view. If one is running a charity dealing with a disease from which people might die, such as cancer or heart disease, a charity for the welfare of children, such as the National Society for the Prevention of Cruelty to Children or Save the Children fund, or a general charity to help old people, those tend to evoke more sympathy. It is easier to attract media attention to such a charity.
Back pain, unfortunately, has a seaside postcard image and people think wrongly that there is something comical about it. There is nothing funny about it at all. It can hurt like hell, waste a huge amount of time and get comparatively little sympathy in relation to the amount of pain which it generates. Any Bill which, as this Bill does, tends to uplift the status of the profession of those who cure and prevent back pain and who care for those with it, and which upholds the professional status of those who cultivate their knowledge and their skill to deal with back pain, ought to be most warmly supported. I hope that, at every stage in the House and in the other place, the Bill will have a fair passage.
The Bill is about the profession of chiropractors, and their professional status, examinations, internal discipline and the upholding of their standards. That almost sounds as if those things are an end in themselves but, with respect, I say that they are not. They are only a means to an end, because the protection of standards is a means to the end of seeing that people are successfully treated for back trouble.
I should like to utter a warning at this point. I believe that professional status is double-edged, and we ought not to assume that professional status invariably promotes the upholding of standards. Sometimes a body that has professional status can tend to rest too much on its laurels. It is essential that professional status is used as a springboard for chiropractors to reach even higher standards, and not as some kind of cushion.
British professionalism in all of the main professions has basically high ideals, and is intended to uphold standards. It is intended to ensure that anyone who is not qualified in that profession is not allowed to practise. It is intended also to impose internal discipline on the members to uphold the profession, to confer a kind of brotherhood within that profession and to exclude anybody who is not up to it. That is the upside of British professionalism.
There is also a downside. I regret to say that I have found in my dealings with members of British professions—whether they have been solicitors, barristers, doctors, dentists, accountants or teachers—that their professional qualifications do not guarantee that people will be good at their jobs. Professional qualifications are a necessary condition, but they are not sufficient to ensure that people will be good at their jobs. If people are to be good at their jobs, professional qualifications are not enough. They need application, dedication, flair, zest, insight and other qualities as well as having letters after their name and having passed examinations or other forms of test.
I have found that in any profession some people are very good indeed, others are not so good and others are hardly any good at all at their jobs, even though they are professionally qualified and can put letters after their name. I hope that chiropractors will bear that in mind after the Bill has been passed and will not harp excessively on technical qualifications. I hope that they will do their utmost to make absolutely certain that personal qualities as well as professional competence are cultivated to ensure that members of the newly established profession do a good job. It is not enough merely to rely on professional qualifications.
I shall now refer to the role of the chiropractic profession in connection with the National Back Pain Association. The association was founded by Mr. Stanley Grundy CBE in the 1960s. He has pledged and instilled support for the association. It has done a great deal of good, so much so that in the White Paper "The Health of the Nation", published in 1992, the Secretary of State singled out five key areas for priority action, namely, coronary heart disease and strokes, cancer, mental illness, AIDS and accidents, but also said that rehabilitation, the health of elderly people, asthma and drug misuse—and back pain—had a strong claim to key area status next time around.
The inclusion of back pain in that list in the White Paper followed a meeting between Mr. Grundy, Lord Joseph, myself and the Secretary of State for Health in the last Parliament, my right hon. Friend the Member for Bristol, West (Mr. Waldegrave). The purpose of that meeting was to stress the great importance of back pain. We asked the Government to accept—as they had already done, but we wanted to re-emphasise it—the great importance of back pain. That was done by the subsequent inclusion of back pain in the list in "The Health of the Nation".
I wish that I had been here earlier to put the point to the Minister. I do not know whether, by leave of the House, he will be able to answer my question. If he is given leave and if he has time, will he tell me what action will be taken in respect of the next five areas of health need, including back pain, especially included as next steps in the White Paper? If he cannot tell me, perhaps he would be kind enough to follow up the matter in a letter to me.
The National Back Pain Association promotes research into treatment of back pain, whether by chiropractors, doctors or osteopaths. It establishes branches throughout the country to promote interest in back pain, to provide facilities in which people can exercise and to spread information. It publishes educational material such as a useful manual for nurses on the correct way to lift patients. Most unfortunately, nurses are especially prone to back pain because they have to lift patients. Sometimes patients have suffered strokes and cannot move—they and other patients have to be turned in bed. So the incidence of back pain among nurses is high. Many osteopaths and chiropractors have to treat nurses who unfortunately suffer from back pain because of an accident of that type as a result of their duties.
I am glad to hear that chiropractic is available within the national health service, whether through GP fundholders or through district health authorities. I hope that it will be available in hospitals.
What worries me is that there are not nearly enough chiropractors. Will my hon. Friend the Member for Aylesbury be kind enough to tell us how many qualified chiropractors there are in the United Kingdom?

Mr. Lidington: There are about 900 practising chiropractors.

Mr. Jessel: That is not nearly enough in view of the fact that the hon. Member for Bristol, South, who has left the Chamber, said that the 310,000 working days are lost every day through back pain, at a cost to the nation of £3 billion. We certainly need many more than 900.
I want the Government, by liaising with the chiropractic profession and colleges, to find out what can be done to increase the number. I realise that that cannot be done too quickly because people must be fully trained so that standards can be upheld.

Mr. Sackville: I can reassure my hon. Friend that we believe that the enactment of the Bill—we hope that it will become an Act—will stimulate the profession considerably, not least because the medical profession and health authorities will have the confidence to refer more patients to chiropractors. They will know that they are referring them to a trained practitioner who is backed by an organisation which has validated that training and has disciplinary powers that enable it to hold the practitioner to account if he or she is not providing suitable treatment. The Bill will greatly stimulate chiropractic as a profession within the national health service.

Mr. Jessel: I am delighted to hear that. I find it most encouraging and I am sure that my hon. Friend the Minister intends to ensure that that happens and that he will promote chiropractic in every possible way, while ensuring that the required standards are maintained. I hope that hon. Members will not cease to remind the Minister of what he has just said.
My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) has done much for the cause of chiropractic and we are all aware of the splendid job that he has done. I have had the pleasure of joining him once or twice on delegations. He has been unceasing in his determination to promote the chiropractor's cause. I have often heard him refer to that and to the chiropractic college in Bournemouth.
I am sure that my hon. Friend will constantly remind the Government of the need to encourage the chiropractic profession to increase its numbers. To be candid—I do not want to be rude to anyone—900 chiropractors is a hopelessly inadequate figure compared to the need for the excellent services that they have to offer. As their professional status is about to be enhanced, provided that the Bill is enacted, their services will be greatly appreciated by the public as more and more doctors refer patients to them. The liaison between the medical and chiropractic professions will also increase and, as a result, back pain—that terrible scourge—will tend to diminish and the health and happiness of the nation will improve. I therefore hope that my hon. Friend the Member for Aylesbury wall have every possible success with the Bill.

Mrs. Angela Knight: This important debate has far-reaching implications for both chiropractors and patients. First, may I apologise to my hon. Friend the Minister for being absent during his speech? I hope that he will understand that it is half-term and I therefore had the complex task of organising my children for another couple of hours so that I could participate in the debate.
From what I have heard in the debate so far, I seem to be one of the few people who has not yet visited a chiropractor. Fortunately, I have not yet suffered from the back pain described by my hon. Friends the Members for Sutton and Cheam (Lady Olga Maitland) and for Twickenham (Mr. Jessel). As I am tall and have small children I shall probably suffer from back pain in the near future, in which case I may have an opportunity to tell the House of my personal experience of the chiropractic profession.
I congratulate my hon. Friend the Member for Aylesbury (Mr. Lidington) on his clear description of this important subject. I also congratulate my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) on his speech, in which he showed his knowledge of other complementary therapies. Again, my knowledge of that subject is lamentable. Since the Bill was published, I, and I suspect many other hon. Members, have been inundated with letters from both the profession and constituents expressing interest in the subject.
I received a letter from a doctor of chiropractic who practises near my constituency but also sees many people who live within the area that I represent. He told me:
The purpose of this registration would be to ensure that no unqualified persons assume the role of a Chiropractor, which could lead to injury or harm being done. Chiropractic is the 3rd largest branch of medicine in the world, with over 60,000 practising doctors … As a Chiropractor my practice is limited primarily to Orthopaedics, although I am trained in general medicine … I have developed a good working relationship with … local GPs and Orthopaedic Surgeons. This allows patients to be treated more effectively ensuring proper treatment and very often cutting down on the time factor.
When we are dealing with people whose exposure to pain is long and debilitating, those final points are extremely valid.
The practitioner also makes a point that was refered to earlier by my hon. Friend the Member for Blackpool, North (Mr. Elletson). He said:
In America the rules regarding Chiropractors along with other professionals are very strict, unfortunately there is no corresponding legislation in England to protect the general public from unqualified persons calling themselves Chiropractors.
The letter clearly defines the fact that the profession wants to be properly regulated as that will benefit both the profession and patients.
The King's Fund working party on the subject consulted widely with the medical professions, chiropractic organisations and individuals involved. All those involved, directly or indirectly, with chiropractic are overwhelmingly in favour of regulation. That is one of the fundamental reasons why the profession should be allowed the regulation that it seeks. My hon. Friends may find it strange that I should say that, as I am a member of the Committee currently scrutinising the deregulation Bill, but I support this Bill from the profession's and the patients' point of view.
An aspect that has been brought to my attention by constituents who have written and spoken to me on the subject is that they have often gone to a chiropractor after going to their doctor. They have tried other forms of medicine before going to a chiropractor. It seems extraordinary that people do not know whether chiropractors have gone through an appropriate training. A doctor usually has a brass plate on his gate or the side of his house saying that he has gone through a long and


complex training. The same brass plate on the chiropractor's gate or on the wall of his house may well say that he has gone through that long and involved training or it may just say that he has decided to set up in practice.
There is a need to protect the profession and the patient by regulating the profession in the way that it wishes. The present situation causes me great distress and concern, and I have no doubt that it is a source of considerable anger to the profession when it sees the unqualified chiropractor in the same queue as the one who is qualified.
I have gone into the subject with my constituents who have sought the help of chiropractors for the relief of pain and I should like to examine two or three matters in the Bill that will play an important part in future and may need detailed attention. My hon. Friend the Member for Aylesbury clearly explained the various kinds of registration and the categories that will apply when the Bill becomes law and when those who are currently practising as chiropractors will be asked to register.
I understand my hon. Friend to say that entitlement to registration will be determined primarily on whether a person holds a recognised qualification. There will be a considerable debate about the interpretation of the phrase "recognised qualification". My hon. Friend commented on that matter but there are a variety of recognised qualifications that are not arrived at via college-based qualifications. There is a need to look at that loose phrase "recognised qualification" to ensure that those who are practising justly and rightly as qualified chiropractors can continue to do so. We must determine in more precise detail exactly what is meant by the phrase.
My hon. Friend the Member for Aylesbury said that there will be transitional arrangements to enable practitioners who may not hold such recognised qualifications but who have practised chiropractic lawfully, safely and competently for some years to be registered. That may address some of the issues, but not all. Those three words "lawfully, safely and competently" could beneficially be extended to many other professions. The advertising profession uses the words "legal, decent, honest and truthful". Perhaps we all have something to learn from the definitions of such phrases.
Those who have not gone through some of the more formal training processes will need, during the registration transitional period, to have formal training, to a common standard, that will enable their skills to be honed and extended to those of the best chiropractors. That may provide the education committee that the Bill will set up with its greatest responsibility and involvement. No doubt it will review existing standards of education and training in the profession and will have particular responsibility for ensuring that the qualifications entitling a practitioner to be registered are recognised and are of the same standard.
Some of my constituents have told me that there is currently some difference between the three training schools and that that results in a difference in the chiropractic treatments that they receive for back neck or other complaints. It would be beneficial to the profession and to patients to bring the training in those schools to a common standard. I trust that an agreement will be achieved between those schools and any future schools of chiropractic training that may be set up, so that we know that the chiropractic profession has the same common standard between the various schools and the training that


individuals receive, like that which exists in the medical profession and the various schools of medicine in this country.
As with any profession, there must also be a way to maintain the standards of professional conduct and competence. It must be relatively simple and a method that protects both the practitioner and the patient. In so many instances, one reads of medical cases where grave concerns have been raised, yet the process and procedure whereby those concerns with the GP have been expressed and aired have meant that many years have passed before the problems have been fully investigated. I am aware that my hon. Friend the Member for Aylesbury has recognised some of those problems and that the Bill attempts to deal with them, and I am grateful for that.
My hon. Friend said that unacceptable professional conduct and professional incompetence are two reasons why someone practising as a chiropractor may, in future, be deemed to be unfit. I ask him to look a little further at whether someone should be totally struck off a register in the same way that a doctor can be, and to the speed and time delays that so often take place in medical investigations. I hope that those problems will not continue in the medical profession and that they will not begin in the chiropractic profession.
Having said that, I should not like to give the impression that I am critical in any way of the chiropractic profession. I am well aware of the immense good that it does, but there is obviously a need to ensure not only that confidence is maintained in the profession but that it is increased as it is more widely used.
My hon. Friend the Member for Bournemouth, East touched on the European dimension. I suspect that it will affect us more closely and perhaps more quickly than might otherwise have been the case because the single market and the movement of people from this country to practise their profession—whatever it might be—in other European countries, and vice versa, make common standards necessary throughout the Community. Perhaps I should address my remarks to him. Many people are concerned that any qualification, whatever it might be, obtained in the United Kingdom might have within it a different set of information and standards from a similar qualification that has been studied for and achieved in another European country.
It is evident that we must ensure that a common standard exists across all countries for all professions, but with the medical professions—in my ignorance I consider chiropractic to be a medical profession, although perhaps complimentary—there is a need for a common standard to ensure that the same knowledge and techniques are the result of the same qualification, whether it be obtained in Britain, Germany, France, Italy or elsewhere in the European Community. That sureness is of particular importance with the chiropractic profession.
My hon. Friends and Opposition Members spoke of the need and desire for chiropractic treatment to be available within the NHS. That subject has caused great interest in my constituency, which has a number of GP fundholders. From that local experience, I am well aware that GP fundholders are able to use part of their budget to employ complementary therapists, such as chiropractors. 'That tendency will grow, not just because of the increase in the number of GP fundholders but because of GPs' increasing awareness of the efficacy of chiropratic and the professionalism of chiropractors.
I do not think it unfair to say that, 15 years ago, chiropractic would have been considered a fringe element of medicine. Like many similar treatments, however, it has become a major item in the body of medical treatment. Many more GPs are now aware of it and, because they will be able to recognise the need to ensure that it is available to patients, patients' reliance on it will increase.
Ultimately, however, the choice of treatment will be primarily a matter for clinicians. I do not feel that I can comment on that aspect but I believe that, as we proceed with our health service reforms, and as district health authorities become aware of chiropractic and other complementary treatments, such treatments will be far more readily available in all our constituencies. My hon. Friend the Member for Twickenham (Mr. Jessel) mentioned the need for more chiropractors. Once the profession is regulated, it will grow and become far more able to operate on a wider basis. I look forward to that very much.
My hon. Friend the Member for Aylesbury has recognised a clear need for future health care, as did those promoting the Osteopaths Bill last year. I suspect that, in the years to come, other complementary health professions will be regulated, as our knowledge and appreciation of treatments other than the aspirin type become greater. I hope that my hon. Friend's Bill will speedily become law; it has undoubtedly got off to an excellent start by receiving all-party support. I trust that that will continue in Committee and I look forward to continuing to support the Bill's passage towards enactment.

Mr. Alan Duncan: I sense that I am "tail-end Charlie" in this constructive debate, but I am sensitive to the wish of Opposition Members to move on to other business. I assure them, and the rest of the House, that I have no intention of detaining them for more than a couple of minutes.
I want to deal with a few points that have not been emphasised sufficiently today; I feel that the Minister and the medical profession should consider them in more detail. The Bill will register chiropractors. Only last year, a Bill was introduced to register osteopaths. That is progress, but it is very slow progress. The legislatory framework for complementary medicine is lagging far behind the consumer's wish to take advantage of a treatment that has proved useful in dealing with conditions that GPs are often unable to remedy.
It was osteopathy last year; it is chiropractic this year. Why not do the same with acupuncture? It seems that we are prepared to approach the question of setting a sensible regime for complementary medicine only in a piecemeal fashion. Homeopathy, too, should be governed by a suitable regime. I am convinced that, in the months ahead, the House will face problems in regard to the labelling of homeopathic medicines. We could debate that subject much more constructively if it were subject to proper regulation.
Although many GPs practising in towns and villages are happy to refer their patients to those who practise complementary medicine, it seems that those who speak for them, especially the British Medical Association, are far too slow and far too unwilling to admit the benefits that complementary medicine can provide. I issue a plea, through the Chair, that the BMA and its ilk should


recognise the advantages of complementary medicine and should jolly well get on with it. They should continue to work more closely with those who are doing their best to heal patients with whom GPs have not succeeded.
I point out to Opposition Members that, in some cases, complementary medicine is available free through the NHS. I should like the provision of complementary medicine to be widened. The old adage that the doctor tells one to take two aspirins and then to come back in the morning is all too frequently true. Such treatment could better be replaced by the acupuncturist's pin or by the osteopath's manipulation. An emerging theme is that, in many cases, back-cracking is a lot better than pill-popping. If we can turn away from taking drugs, chemicals and pills, we shall all be the better for it. I commend the work of my hon. Friend the Member for Aylesbury (Mr. Lidington) and I commend the Bill to the House.

Question put and agreed to.

Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).

Nursery Education (Assessment of Need) Bill

Order for Second Reading read.

Mr. Nigel Spearing: I beg to move, That the Bill be now read a Second time.
As the long title says, the Bill would
Require local authorities to have regard to the need for securing that provision is made for pupils who have not attained the age of five years by the provision of nursery education as in section 8(2)(b) of the Education Act 1944.
Some hon. Members may wonder what the Bill is for if that provision is included in the 1944 Act. The reason is that, possibly by accident, that section is no longer in the Act. The purpose of the Bill is simply to reinsert that provision into statute.
I hope that, as was the case with the Chiropractors Bill, this Bill will meet with universal approval. I have yet to hear of an hon. Member who disapproves of it; indeed, I have yet to hear of anyone in the country who disapproves of it. I hope, therefore, that it will receive a passage through Parliament as agreeable as that given to the Chiropractors Bill.
The Bill, I point out to the Minister, is entirely compatible with everything that has been said by the Secretary of State for Education and with everything that has been said and written, almost weekly, by the Prime Minister. Without such a provision, how can one sensibly go forward to expand any form of under-five provision in any local authority? How can we go forward without considering the needs and without seeing how the available resources can best be distributed? I realise, of course, that the resources are by no means unlimited. I shall not go into the matter today, but I hope that we shall have further discussion about what the resources should be.
The number one point is the assessment of need. Nursery education is favoured by all parents, whether they wish to use the facilities or not. Nobody, as far as I am aware, opposes such provision. Nursery education is a basic need in the community and, if I may say so, "society". I am sure, therefore, that nobody here will do anything to prevent the Bill from being given a Second Reading this afternoon. If anyone does, I shall have to ask why.
Why are people so keen on nursery education? I have here a formulation, which is not well known but cannot be bettered. It states:
It is now considered that the self-contained nursery school, which forms a transition from home to school, is the most suitable type of provision for children under 5. Such schools are needed in all districts, as even when children come from good homes they can derive much benefit, both educational and physical, from attendance at a nursery school. Moreover, they are of great value to mothers who go out to work, and also to those who need relief from the burden of household duties combined with the care of a young family … There is no doubt of the importance of training children in good habits at the most impressionable age and of the indirect value of the nursery school in influencing the parents of the children. There is equally no doubt of the incalculable value of the schools in securing medical and nursing care, and the remedial treatment of defects which may be difficult to eradicate if they are left untreated until the child enters school in the ordinary way at the age of 5.
From what we know of all that has been written on the subject, we can all agree that that is a pretty good summing up of the universal approval of nursery education. I was quoting from Command 6458 of July 1943, the great


Butler and Ede White Paper which preceded the Education Act 1944. In these modern times, it is worth noting that it consisted of 36 pages of A5 and cost 6d, which is rather less than 3p. It was good value for money.

Mrs. Audrey Wise: I have read many of the reports issued by the Office for Standards in Education and I have noticed that they comment specifically on what proportion of children have access to proper pre-school provision. Clearly, my hon. Friend's quotation from the past is matched by the present concern of a Government organisation.

Mr. Spearing: I am grateful to my hon Friend for underlining the universal agreement about the need for nursery education.
My next quotation is taken from the Hansard report of the House of Commons, meeting in another place, on 19 January 1944, 50 years ago last month. In moving the Second Reading of the then Education Bill, none other than R. A. Butler said:
the country seems to have a special bent for nursery schools. These are not only social centres of training and up-bringing for the children, but have a real educational value and are often centres of adult education for the parents themselves. Therefore, I hope that we shall see, arising from this Bill, a healthy development of nursery schools, and/or classes where they are more expedient, and that we shall find that they buttress and support home life and make no attempt at supplanting it"—[Official Report, 19 January 1944; Vol. 130, c. 212.]
As my hon. Friend the Member for Preston (Mrs. Wise) said, almost every report since then has emphasised the need for nursery education, for example, the Plowden report and Lady Thatcher's White Paper, which was scuppered by the energy crisis—we had to do something about that crisis, I suppose.
More recently, an independent commission on education said in its report last year:
High-quality publicly-funded education provision should be available for all 3-and-4 year-olds.
I shall not go into the details of general provision for the under-fives but everyone agrees that nursery school has an important part to play.

Lady Olga Maitland: Does the hon. Gentleman accept that 90 per cent. of three and four-year-old children in England currently attend some form of pre-school education?

Mr. Spearing: The hon. Lady is right, but I do not want to go too far down that road because it is outside the scope of the Bill. There is discussion in all quarters—educational as well as Government quarters, for all I know—about the benefits of different forms of pre-school education. Nursery education as such is defined by qualifications of teachers, the number of available rooms, the facilities in a nursery school, the ratio of teachers qualified in the subject and the amount of nursery assistance. It was understood in the 1944 Bill and has been ever since. Although the hon. Lady's statistics are right, I do not want to get drawn into the overall proportions, because the Bill in 1944 and the Bill before us are about nursery education, which nobody denies is necessary and helpful.

Lady Olga Maitland: rose—

Mr. Spearing: I hesitate to give way again to the hon. Lady, but I shall for the last time on that particular point if she wishes.

Lady Olga Maitland: I thank the hon. Gentleman for allowing me to intervene again. Further to the principle of nursery education, does he accept that the needs of tiny three or four-year-old children are diverse? Surely it must be appropriate that parents have the choice of appropriate pre-school education for their child. Formal nursery education is not always appropriate for every child.

Mr. Spearing: I am not sure that I claimed that it was. I do not think that anybody, even the most enthusiastic supporter of what the hon. Lady tends to deem as over-rigid education—although it is not in my experience—would make it compulsory through a local education authority. The decision is open to parents. As the hon. Lady knows full well because of the statistics, many more parents wish their children to go to such nursery schools, but for one reason or another they are not able to send them. That is a fact that she would not deny.
I shall return to the Bill. The Education Act 1944 did not require local education authorities to make nursery education compulsory. It is important that the terms of nursery provision, as contained in section 8(2) of the 1944 Act, are on the record. As enacted, it read:
In fulfilling their duties under this section, a local education authority shall, in particular, have regard—
(a) to the need for securing that primary and secondary education are provided in separate schools;"—
there were some all-age schools at that time
(b) to the need for securing that provision is made for pupils who have not attained the age of five years by the provision of nursery schools or, where the authority considers the provision of such schools to be inexpedient, by the provision of nursery classes in other schools".
Perhaps by accident or an oversight, due to some disagreements about funding in 1980—I happened to be in the Chamber when the discussion took place—the former Secretary of State for Education and Science, Mark Carlisle, now Lord Carlisle, introduced a new clause which allowed local education authorities to spend money on nursery education. There had been an argument over whether sections 8(2) (a) and (2) (b) allowed them to spend money. Many hon. Members said they did not.
In giving the local authorities that power to spend money on nursery education, I think that, by an oversight, section 8(2)(b) was repealed, and the need for securing that provision does not exist any more. I do not think that we need to go too deeply into the reasons for that; it would take a long time to detect what went on. I was in the Chamber at the time and have read the debate in Hansard and I do not think that any indication was given that, by accepting the new power to spend money and making it specific, the House repealed the section which I want to reinstate.
So what should be done? As I have said, I do not want to delay the House much longer, but I see no reason why anybody should wish to oppose what was in the 1944 Act. If we are to have nursery education as part of the under-fives provision and as part of a mix, whatever that mix may be, however the resources are used and however it is funded—there are disagreements about that, so I hope that I carry the hon. Member for Sutton and Cheam (Lady Olga Maitland) with me in all that I am saying—it is right and proper that there should be a duty on a local education authority to provide such comprehensive provision and choice for parents. Such a provision should be on the statute book and at the moment it is not.
The section was in force from 1944 until 1980. It was important because it focused on the local community, local society and local need. The White Paper which I quoted and the Bill that followed it were the result of the enormous nationwide consensus that existed, not only among political parties but among the Churches, educationists and teacher organisations. In those formative years, everyone made their suggestions and they were broadly incorporated in the epoch-making 1944 Act by R. A. Butler.
The Education Act 1944 was passed 50 years ago last month. It was unopposed on Second Reading and on Third Reading. The provision on nursery education was never questioned. It was passed by a House that contained a majority of 250 notional Conservative Members—there was a national Government. That makes the subject even more important because the consensus existed 50 years ago, as I hope it does today, among hon. Members who were elected in 1935. Those people thought that the legislation was right then, and there was no discussion about it, except for legal reasons, for about 30 years, so who can oppose it today?

2 pm

The Parliamentary Under-Secretary of State for Education (Mr. Robin Squire): It may be for the convenience of the House if I speak now rather than later in the debate. I apologise to the hon. Member for Newham, South (Mr. Spearing) for missing his first few sentences. He is a near neighbour of mine and we have had occasion to do battle together in the past. I pay tribute to his persistence on this issue and others and I congratulate him on his fortune in drawing this slot in the annual ballot.
There is no difference between much of what the hon. Member for Newham, South said and what the Government say about the importance of nursery education. If time allows, I shall go into greater detail about the provision of nursery education by local authorities of different persuasions. Let there be no disagreement between us that for many children nursery education represents an important start to their full education, which they enter from the age of five.
It might, however, be of use to the House if I concentrate immediately on the legal impact of the Bill. It would restore a provision, section 8(2)(b), which, as the hon. Gentleman made clear, was originally part of the Education Act 1944 and was amended in 1980. The section should be understood in the context of the statutory duties that the legislation imposed on local education authorities.
I shall paraphrase a little to save some time. Section 8(1) of the 1944 Act states:
It shall be the duty of every local education authority to secure that there shall be available for their area sufficient schools—
(a) for providing primary education, that is to say, full-time education suitable to the requirements of junior pupils; and
(b) for providing secondary education".
Section 8(2)(b), to which the Bill refers, mentions:
the need for securing that provision is made for pupils who have not attained the age of five years by the provision of nursery schools or, where the authority consider the provision of such schools to be inexpedient, by the provision of nursery classes in other schools".
According to the original form of words used in the 1944 Act, the local education authority was required to
have regard … to the need for securing that provision is made for pupils who have not attained the age of five years".

It does not state that local education authorities must make provision; it merely states that authorities should take such needs into consideration.
That was an imprecise duty and was impossible to enforce. That was the view taken not long after the 1944 Act came into force. Over the years, the view that provision for nursery education was a discretionary power for local authorities became quite widely held, and they took that view themselves. More importantly, everyone acted as though that were the case.

Mr. Spearing: I do not think that I disagree with anything said by the Minister, but even if the authorities did not have the power, they had the duty to have regard and they had a legal duty to undertake some sort of assessment. That is what my Bill, if passed, would do, and that may sit well with current legislation.

Mr. Squire: If the hon. Gentleman will bear with me, I shall seek to respond to that precise point and the impact of his Bill.
Section 8(2)(b) no longer exists. As the hon. Gentleman made clear, it was repealed by the Education Act 1980. The reason for that move was quite clear—

Mr. Spearing: Not to the House.

Mr. Squire: Well-when introducing the amendment that effected the move, the then Secretary of State for Education and Science, Mark Carlisle, said:
I do not believe that it is wise to leave the law unclear on this matter. It is necessary to make it clear, and in the amendments I am attempting to bring the law into line with what it was always thought to be."—[Official Report, 12 February 1980; Vol. 978, c. 1279.]
Section 8(2)(b) was repealed by section 38(6) and schedule 7 of the Education Act 1980. Section 24(1) and (2) made new statutory provisions for under-fives. It stated:

"(1) A local education authority shall have the power to establish nursery schools, to maintain such schools established by them or a former authority and to assist any such school which is not so established.
(2) A local education authority shall not by virtue of section 8(1)(a) of the Education Act 1944 be under any duty in respect of junior pupils who have not attained the age of five years but this subsection shall not affect the power of an authority under section 9(1) of that Act to establish, maintain or assist a school at which education is provided both for such pupils and older pupils, including a school at which there is a nursery class for such junior pupils as aforesaid."

It is important to quote those lines as the 1980 Act is the trigger for the hon. Gentleman's Bill.
The form of words covering local education authorities' responsibilities for under-fives is no longer ambiguous. The practical effect of the original section of the 1944 Act and section 24 of the 1980 Act is exactly the same. Therefore, if enacted, the hon. Member's Bill would achieve precisely nothing. Worse than that, we would be returning to an imprecise form of words that would flatter to deceive. The Bill is, therefore, unnecessary and adds nothing to the current duties of local authorities.
I am conscious that other hon. Members wish to speak, not least the hon. Member for Bridgend (Mr. Griffiths), so I shall curtail some of the comments that I would otherwise have made. However, I must clarify where the Government stand. We have made it clear that we should like to see a widening of nursery and other pre-school provision as resources become available. Our longer-term ambition is availability for all those who want it. Much has already


been achieved and my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) made passing reference to that a moment ago. Over half of all three and four-year-olds now attend maintained nursery and primary schools, and more than 90 per cent. receive some form of pre-school provision.
We intend to explore ways of adding still further, as resources allow, to the choice that parents have among the range of provision—public, private and voluntary. As well as encouraging that choice and diversity in response to children's needs and parents' preferences and circumstances, the Government will continue to promote quality and cost-effectiveness.

Mr. Spearing: It would be helpful to take up the Minister's point. He claims that the Bill will do nothing. Of course, section 24 of the Education Act 1980, which provides specific power in this area, is fuzzy. Does he agree that if the Bill is enacted—I do not see any reason why it should not be—it will provide a duty and an obligation on the local education authority to make the assessment of need even if other people fulfil it? Therefore, it will make a difference because section 24 provides only a power to spend—it does not provide a duty to survey and assess the need of nursery education in respect of all the other points to which the hon. Member for Sutton and Cheam (Lady Olga Maitland) referred.

Mr. Squire: I can only reiterate my earlier words that in practical terms—I am sure that, like me, the hon. Gentleman is most concerned about that—and in the form of the words that would be reintroduced, I have been advised that there would be no gain from this proposal and we would have the loss of going back to a less precise form of wording than was introduced by the 1980 Act, to which both the hon. Gentleman and I have made copious references.
I shall continue my comments on Government policy and review. My right hon. Friend the Secretary of State has made it clear that there are no preconceptions about the results of our current study. In other words, nothing is ruled out and, indeed, nothing is ruled in at the moment. Nor is there a set timetable and, therefore, in fairness I do not expect to produce solutions overnight. However, when we are ready to make an announcement, we shall do so in the normal way and allow the House an appropriate opportunity to debate the issues.
I shall say a few words about other types of provision, to which my hon. Friend the Member for Sutton and Cheam made passing reference earlier. We do not see playgroups as a poor substitute for nursery schools or classes. A playgroup is a distinct form of provision with its own ethos and strengths, geared towards meeting an identifiable parental need. Most playgroups take their educational role seriously and now provide a rich source of experience, preparing children for primary schooling and the national curriculum. We recognise that some playgroups may not come up to scratch but many, if not most, are excellent.
As a means of delivering pre-school education, playgroups have shown that they can achieve results. In recognition of that, the Department has substantially increased its grant for the training activities of the Pre-School Playgroups Association to £887,000 in the current year. The Department of Health and the Ministry of Defence also make grants to the association.
So that the House may have some idea of the scope of the activities, at the latest date for which I have information, some 770,000 under-fives are in playgroups. I am sure that hon. Members would agree that that is a significant proportion of under-fives. As I said, overwhelmingly they are enjoying a good provision that prepares them for schooling.
I shall say a few words about the role of local education authorities. I am sure that the hon. Member for Newham, South would agree that, whatever our differences on the wording of his Bill, it is right that local education authorities should have a power and not a duty to provide for the needs of under-fives. We believe that a policy of local determination of under-fives services is necessary if we are to ensure that local authorities and other providers are able to respond to the specific needs of their areas. It is better for that to remain a local decision, rather than it becoming a duty imposed by the Government. That is the thinking behind the LEA funding arrangements.
The present arrangement assumes—I know the hon. Member for Newham, South knows this from our discussions when I was wearing another ministerial hat—that the under-five population is one of several client groups and the arrangement distributes formula funding according to the total size of that population in each LEA.
Funding LEAs by reference to the policies of each individual authority on the discretionary provision that they make for under-fives—some hon. Members have urged that in the Chamber and in correspondence with me—would be at odds with the present system, which is based on the concept of the objective calculation of the need to spend to provide a standard level of service. The settlement for 1994–95 allows for local authorities in England to spend £17,087 million on education—an increase of 2·4 per cent. on this year's figure, once changes in function are taken into account. Of course, spending priorities are for each authority to determine.
It is important to put on the record that it is sometimes suggested that the provision of nursery education in this country in some ways lacks in comparison with that of other countries. Those who make that comment rather overlook the fact that no other European country has a longer period of statutory education than the United Kingdom. The 11 years which all our pupils are expected to enjoy, or for which they are expected to be at school, is longer than almost any other country. I am advised that it is equalled only by the Netherlands.
It is important to bear in mind when making any international comparisons that most other countries commence mandatory statutory schooling at the age of six, or seven in a number of cases, whereas our children start their formal education at the age of five.

Mr. Don Foster: Does the Under-Secretary agree that statistics show that, in respect of nursery education for three and four-year-olds, this country comes bottom of the league of European countries with the exception of Portugal?

Mr. Squire: I am suggesting that simple comparisons based only on nursery education and taking no account of the age at which statutory education starts are, frankly and with due respect to the hon. Gentleman, a little facile.
We must look at the range of provision. In one or two of the EC countries which the hon. Gentleman and I would identify as natural competitors, a significant proportion of


nursery funding comes via voluntary or private means, and not from the state sector. My hon. Friend the Member for Sutton and Cheam made it clear that more than 90 per cent. of three and four-year-olds attend either education or group day care. That is an impressive figure against the background of compulsory full-time education from the age of five.

Lady Olga Maitland: My hon. Friend refers to comparisons with nursery education in Europe. Does he agree that European countries do not have statutory obligations for the provision of nursery education? Is not it the case that, in Germany, 71 per cent. of children attend nursery education that is privately funded?

Mr. Squire: My hon. Friend makes more accurately than I did the point that I was making. We all use international comparisons but it is difficult—particularly in this sector—to be sure that we use the same basis.
For the record—the hon. Member for Bath (Mr. Foster) raised the issue—apart from the 90 per cent. of three and four-year-olds that I have mentioned, the figures break down as follows: 26 per cent. of three and four-year-olds are admitted to maintained nursery schools and classes. I pay tribute to the percentage in Newham, which has arguably one of the highest attendance rates in the country with 64 per cent. Of that 26 per cent., 4 per cent. are in nursery schools and 22 per cent. are in nursery classes; 24 per cent. are admitted to infant classes in maintained primary schools—mainly four-year-olds in reception classes—and 4 per cent. are admitted to special or independent schools. So, including pupils in independent and special schools, the overall school participation rate is 55 per cent.
In addition—I am quoting the 1992 figures—41 per cent. of three and four-year-olds attend playgroups. Some of those may go on to under-five schooling during the year and may also be counted in the above figures. About 5 per cent. receive other group day care. Most playgroups are affiliated to the Pre-School Playgroups Association and cater for some 770,000 children or 21 per cent. of all under-fives. More importantly perhaps in this discussion, such playgroups involve some 250,000 parents in running them. So the playgroups pass on parenting skills. As for four-year-olds, 84 per cent., excluding rising-fives, are admitted to maintained nursery and primary schools. Such schools also admitted some 201,000 rising-fives.
I am conscious that the time is making me hurry more than I should. The figures show that a significant range of options is open to under-fives. That emphasises the improvement that has taken place during the time that the Government have been in office.

Mr. Don Foster: Does the Minister accept that his announcement of all those statistics somewhat belies his opening remarks, in which he said that he fully supported the need for the expansion of nursery education in Britain and that the Government were exploring ways of expanding it, as resources allowed? He said that nothing was ruled out and nothing was ruled in, that there was no fixed timetable and that he made no promises. Do not his subsequent remarks show that all those opening words were nothing but hollow promises?

Mr. Squire: I shall avoid phrases such as "hollow promises" in connection with the hon. Gentleman's party and try to keep the debate on a level keel. If, having heard what I said, and repeated, the hon. Gentleman comes to that conclusion, I cannot help him. I have made it clear today that we are committed to an expansion of provision, certainly including nursery education. The form and timing of that expansion is still to be determined and will be brought before the House in the usual and proper way. I may say gently to the hon. Gentleman that it is perfectly possible to support nursery education and still see the advantage of other forms of pre-five provision, which would be lost if we moved to a position in which the only provision available was nursery education funded and provided by the state.
I am conscious that the clock is our worst enemy today. I hope that I have explained why I believe that the Bill is unnecessary and would add nothing to the present requirements under the law. I also hope that I have given good intent as to what the Government will in due course announce over the range of provision for pre-fives.

Mr. Win Griffiths: I was surprised that the Minister rejected the modest proposal made by my hon. Friend the Member for Newham, South (Mr. Spearing). My hon. Friend made an eloquent case for reintroducing part of the Education Act 1944 to make education authorities at least consider the need for nursery education in their areas. They would have to assess the needs and draw up a plan which might be implemented over a five or 10-year period. In drawing up the plan, local authorities might find that some parents wanted a nursery place for their child but others were happy with playgroup provision. The proposal does not exclude playgroups. One of the purposes of a sensible policy on pre-school education is to introduce quality criteria, which will enable all sectors to be involved in provision.
I imagine that the Minister already knows that the Pre-School Playgroups Association would be happy to have facilities similar to those available in nursery schools and units. The lack of such facilities is one of its major problems when trying to deliver quality education to the children who attend its groups.
The association is also concerned about training. The Minister should not claim responsibility and praise for the additional money for training people involved in the pre-school playgroup movement, when no similar concerted effort has been made to ensure that the same happens in nursery schools and nursery education.
The plain fact is that only two out of the 40 best providers of nursery education are Conservative-controlled authorities—one is Liberal Democrat-controlled and in a few authorities there is no overall control, but 34 are Labour-controlled. None of the 25 worst providers is Labour-controlled. Why? Because Labour authorities accept the commitment for providing for three and four-year-olds implicit in the standard spending assessments, but unfortunately far too many Conservative-controlled authorities do not.
In the debate about nursery schools, units and playgroups we should concentrate on the delivery of a quality service. The best research on the subject was the Ypsilanti project at the Perry school in Michigan. For 27 years, it studied the lives of 130 people, comparing those


who had received a good-quality nursery education with those who had not. That study shows that every dollar invested in good-quality nursery education has saved the taxpayer seven dollars during that 27-year period, because the people who experienced such education were far less likely to become involved in crime, more likely to get good qualifications, had fewer special education problems in school and got better-paid jobs and paid more taxes in later life. That is why the Government should be committed to such a programme.

Mr. Robin Squire: If the demands of time had not been what they are I would have mentioned research. I do not expect the hon. Member to accept this from the Dispatch Box, but I assure him that conclusive research on the subject is very elusive. We shall return to it in future debates, but I would not want him to think that my silence represented 100 per cent. assent with his words.

Mr. Griffiths: I realise that some of the evidence is contradictory, but the Ypsilanti project was the most thorough study of nursery education anywhere in the world. Many other elements play a part, such as the low pupil: teacher ratios, a curriculum appropriate to the child's development and parental involvement. That is why we should consider that research carefully.

Lady Olga Maitland: I thank the hon. Gentleman for giving way at such a crucial time. He mentioned the analysis, based on research in America, which suggests that some children are less likely to turn to crime. Does he not agree that children should learn to distinguish right from wrong and that that is something that they need to learn throughout their lives? It is totally spurious to say that everything results from their nursery education.

Mr. Griffiths: It is not totally spurious. Good-quality nursery education is important because it helps young people to develop social skills and awareness and so they are less likely to become involved in crime at a later date.
Obviously, other factors are involved but that one is important. I hope that the Government will support the Bill and allow it to go to Committee so that it can be amended to take account of the specific purpose of those who have presented it.

Lady Olga Maitland: I welcome the chance briefly to contribute to this debate. In this International Year of the Child it is appropriate that we should focus on children, their development and nursery education.
I welcome the Government's wide-ranging initiatives in putting an enormous amount of money, commitment and emotional concern into ensuring that our children have the best possible start in their careers. I am somewhat puzzled, however, by the decision of the hon. Member for Newham, South (Mr. Spearing) to introduce this Bill because there is clearly some confusion within his party about its commitment to universal education.

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed on Friday 25 February.

Remaining Private Members' Bills

RACE RELATIONS (REMEDIES) BILL

Read a Second time.

Bill committed to a Committee of the whole House.—[Mr. Vaz.]

Bill immediately considered in Committee; reported, without amendment; read the Third time, and passed.

PROTECTION OF DOGS BILL

Order read for resuming debate on Second Reading [4 February].

Hon. Members: Object.

Mr. Deputy Speaker (Mr. Michael Morris): Debate to be resumed what day?

Mr. Tom Cox: With the authority of the Member concerned, Sir, Friday next.

Debate to be resumed on Friday 25 February.

HEDGEROWS BILL

Order for Second Reading read.

Hon. Members: Object.

Mr. Deputy Speaker: Second Reading what day?

Mr. Cox: With the authority of the Member concerned, Sir, 18 March.

Second Reading deferred till Friday 18 March.

HORSES (PROTECTIVE HEADGEAR FOR YOUNG RIDERS) (AMENDMENT) BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 4 March.

Icknield High School

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Andrew Mitchell.]

Mr. John Carlisle: I am grateful for an opportunity to bring to the attention of the House a matter of great importance to my constituents and also to my hon. Friend the Minister, whom I am pleased to see on the Front Bench this afternoon. It concerns a capital grant applied for by the Icknield high school in my constituency and rejected by my hon. Friend and his colleagues.
As my hon. Friend will know, my constituency has two grant-maintained schools—Icknield high school and Lea Manor school. I hope that Cardinal Newman school will soon join them because it has applied for grant-maintained status but is still awaiting a reply from my hon. Friend. Although the result of the ballot has been favourable, my hon. Friend is now looking into the matter. Perhaps the Minister would comment on what progress, if any, has been made on that matter.
Icknield high school is the largest of its type in Bedfordshire, with which you are well acquainted, Mr. Deputy Speaker. It has some 1,300 pupils at the moment, and the number is rising. There is a waiting list—which is not unusual for the school—for September, and the school is already oversubscribed by 120 pupils. That is because the school has excellent academic and sporting results. I hesitate to say that it is the best school in my constituency but it is certainly in the top category of the many excellent schools in my area.
The school has an extremely high standard of discipline, of which it is justly proud. The uniform is widely worn by the pupils and accepted by parents. I have no hesitation in representing with pride to the House and the Minister the interests of the school because of its excellent achievements since its formation in 1949. I pay a special tribute to the staff, and especially to the head teacher, Mr. Keith Ford, and his deputy, Mr. Colin Cabon, who have worked hard since the school obtained grant-maintained status in April 1993. I also pay tribute to the governors under their chairman, Councillor Pauline Dunington, who have made certain that the school stays at the top of the league.
It is with some sadness that I bring to the Minister's attention the fact that the capital grant application that the school was invited to submit for the 1994–95 financial year, has been turned down. As long ago as 1991 the local education authority—at that time the governing authority for the school—said in a report that there was a backlog of repairs which might cost about £5 million. One of the reports stated that the authority judged that the buildings had reached the end of their useful working life and were in need of major repairs. At that time the authority even discussed complete replacement of the school.
Since the school became grant maintained, it has been visited by representatives of various bodies and, in particular, by Mr. Adrian Pritchard, who was the director of the Grant-Maintained Schools Trust and is obviously well known to my hon. Friend the Minister. He described the school as having
the second worst grant-maintained school buildings in the country.

That was confirmed to a certain extent by Sir Robert Belchin, the chairman of that august body, who insisted on putting Icknield school "high on his agenda". I understand that those were his words.
For those reasons there was great disappointment when the Department refused the capital bid and raised doubt about whether it would be possible to submit design bids for 1995–96, although I think that that matter has now been cleared up and that a capital bid would be welcome. Private consultants who looked at the buildings said, perhaps contrary to some people's opinions, that they could be saved, provided there was sufficient and urgent investment in the structure and services surrounding them.
The number of pupils at the school has increased dramatically in recent years. The roll predicted for 1996 is up to nearly 1,400, and the prediction for the year 2000 is 1,560. That shows the school's popularity and the difficulties that it will face if it increases its roll or even if it tries to stand still, given the conditions of the buildings in which the staff and pupils have to work.
Although the governors are trying where they can to reduce the current number of pupils in line with the age of the buildings, they are finding it extremely difficult because, as the Minister will understand, this popular school is being asked by parents well outside its catchment area whether places are available.
As I have said, the school was opened in 1949 and at that time consisted of separate boys' and girls' schools. It was suggested that it should double as an emergency military hospital. I hope that the Minister will visit the school. If he does, he will notice the familiar signs of a hospital because he will see bare brick walls, an asbestos roof—about which I shall say more shortly—concrete floors, fibreboard ceilings and virtually no insulation. Needless to say, the life of the staff and pupils is still a happy one, but they are working under severe difficulties.
Additions were made to the school in the 1950s and 1960s, but the buildings were never upgraded to the standard that one would expect, certainly of the 1990s. No major investment has been made at the school since 1968–70 apart from repair to part of the building which, unfortunately, was damaged by fire some years ago. Obviously, because of its age, the building has deteriorated over the years. Large amounts of money have been spent on repairs, but never sufficient to stop the general deterioration in the condition of the buildings. It is distressing that almost every day the health and safety legislation is being broken because pupils attend the school.
Throughout this time the school has remained cheerful. Since becoming grant maintained, it has had a vigorous self help scheme, which has involved voluntary help in redecoration. It is delighted with its GM status, but some of its problems are beyond the wit, and indeed the ability, of amateurs who are trying on a do-it-yourself basis to patch up the building and make it presentable, rather than tackling the fabric of the building.
The school was a candidate for a bid, and it was advised by the Department to apply. It was advised at that time—possibly this was its mistake—to apply for a single bid, which would have covered all its various problems: health and safety; science teaching; overcrowding; and, of course, the ever-growing number of pupils. It realised that the bid had to be put in, because if it was to meet the health


and safety standards, as demanded by local authorities and legislation, some improvement would have to be made, and fairly quickly.
The complete bid was on a basis of phasing over some two years. The cost, as my hon. Friend will know, was some £1·6 million. Unfortunately, the bid was unsuccessful. The failure of the bid is probably the most worrying thing for my constituents and the school. I cannot emphasise enough to my hon. Friend that the school now faces a health and safety crisis. If something is not done extremely quickly, in the summer term of this academic year, it may have to send pupils home, because it is not up to the standard demanded by current legislation or the local authority.
The school faces a further serious problem, relevant to the fact that it is now grant maintained, in that it is extremely difficult to find an insurance company that will provide cover. My hon. Friend will know—I perhaps guess at this—that the school could not carry on as a legal entity unless it was fully covered by insurance. Unless some of those improvements are made, it will find it extremely difficult—nay impossible—to find an insurance company that will give it the cover that it and the legislation demands.
My hon. Friend will forgive me for talking of matters of construction rather than of education, because I am perfectly happy—as are the parents—with the education that pupils get at that school. My point is about the fabric. The first priority to avoid the closure of the canteen—for action during, if not before, the Easter holidays of this year—is on three bases. First, the kitchens must be brought up to requirements. If they are not, they will close and some 600 school meals will not be served. That will obviously be a problem and will cause severe embarrassment to myself, the governors and staff.
Secondly, the cold water system and incoming mains are incredibly old. There is some hint, but no more than that, of the possibility of zinc poisoning. It is not for me to put any fears in the minds of parents about the health of their children, but that has been pointed out in some plans. The cold water system and incoming mains must be improved.
Thirdly, an immediate concern is the domestic hot-water system itself, which, I believe, has never reached the required hot-water standard—whatever that is. The boilers have been bastardised—I hope that you will forgive the expression, Mr. Deputy Speaker—by the use of "two into three": that is a construction term, meaning taking from one and giving to the other two. The boilers are now incredibly lame, and—dare I say—would not be fitting for this place, let alone for one of my constituency's flagship schools.
The total cost of those three items is £187,000. I know that an emergency fund exists, and I ask my hon. Friend the Minister to consider urgently the possibility of using at least that amount for the school.
The second priority is action that will be required by September 1994, because of the impending cold weather. There are safety hazards in the boiler room. The caretaker is a very honourable fellow, who spends a good deal of his time manually raising the temperature of the water to the required levels—which may not be the highest levels—at some risk to his own safety. A good deal of mechanical and electrical work is needed in that boiler room. I do not wish to give the House the impression that I have any great mechanical knowledge—perhaps my hon. Friend the

Minister has: he is nodding—but the school assures me that this is very important. I do not want levity to lessen the impact of what I am saying.
The other part of this second priority is the need to improve the laboratory services and fittings, which are old and inadequate for the modern needs of school children. The Government are rightly anxious to encourage science teaching in our_schools, for it is from them that young scientists wilemerge; at present, however, the facilities are not up to the standards that my hon. Friend the Minister would expect.
The third priority—which must be dealt with in the longer term, but which is nevertheless necessary—is a phased replacement of the asbestos roof and the installation of fire breaks. I do not need to go into the details; my hon. Friend will understand that the roof must be replaced as soon as possible—as soon as money is available for the purpose.
My hon. Friend may be somewhat surprised that I should ask for an increase in some form of public expenditure. He and I came to the House together in 1979. Although we sat on the same Benches, we had different opinions on various matters; but the fact that he is now on the Front Bench and I am still on the Back Benches may give some idea of his abilities. I now ask him to overcome any prejudice that he may feel about my public-expenditure policy: after all, every hon. Member is allowed a little discretion on occasion.
Disturbingly, the school's reaction to the rejection of the bid was somewhat contrary to information that my hon. Friend may have been given. Was the bid looked at properly? The school received letters—not least a letter from 10 Downing street, and also a letter from the head of the grant-maintained schools services division. One letter stated:
Ministers' assessments of your proposals for 1994–95 took account of scrutiny by members of the capital team, by Ofsted"—
that is the Office for Standards in Education—
and by our professional advisers in Architects and Buildings Branch.
The letter from 10 Downing street said the same: the bid had been carefully looked at, and that
included assessments by architects at the Department for Education and by the Office for Standards in Education".
According to what I have been told, no official came from the Department—or, indeed, from Ofsted—to look at the buildings. The report seems to be based purely on the capital bid put forward by the school, admirable though it was. It is beyond me how it can be said that scrutiny took place when no one physically went to examine the position.
My hon. Friend should look into that matter. Ofsted has now arrived on a preliminary basis and will look at the school over the next few weeks. However, it had not arrived when the report landed on my hon. Friend's desk. The fact that there had been no official visit by Ofsted goes some way towards explaining the school's dismay at the Department's reaction.
There is an immediate and extremely urgent need for the grant. I hope that my hon. Friend will be able to give the school some comfort in his response this afternoon. I cannot stress too much to him the urgency of the situation and the fact that a crisis will occur if priority one works are not carried out. It is not right that the school should have no other source of funding—the school does not complain


generally because it enjoys grant-maintained status—to help put things right and to make the children legally able to go to the school.
My hon. Friend, above anybody else, is extremely welcome to visit the school at any time that is convenient to him. I have been asked by the head teacher to pass on that invitation to him. I hope that when my hon. Friend comes to the school—I am confident that he will come—he will be able to see the works that, I am sure, he will promise will be carried out.

The Parliamentary Under-Secretary of State for Education (Mr. Robin Squire): I congratulate my hon. Friend the Member for Luton, North (Mr. Carlisle) on securing this debate and on the manner in which he deployed his case. If there are any points at the end that he feels that I have not addressed, I know that, with his usual persistence, he will bring them to my attention. He mentioned that, like me, he is what must seem like a veteran on the 1979 intake. Those of our intake are very good on timing and nothing could be better on timing than for this debate to take place on an afternoon when an earlier debate also necessitated my attendance.
My hon. Friend made a passing reference to Cardinal Newman school. I shall respond on that point equally briefly. I am aware that the matter has been outstanding for some time. I assure him that we are doing our level best to bring the outstanding issues, some of which are quite complex, to a successful conclusion. I undertake that I shall reach that conclusion as soon as I possibly can.
The main issue of the debate is Icknield high school. I have noted my hon. Friend's kind invitation to visit the school and I hope that in time I shall be able to respond to it. Let me make it clear that capital grants for self-governing schools come under two different categories. First, there is a formula grant which all self-governing schools can claim, which is for small-scale capital works. For 1994–95, it is an average of £28,000 for a secondary school, with a minimum of £16,000. I may say more about that later. Secondly, for major capital projects, schools are invited annually to submit bids. They are evaluated on a competitive basis against the criteria announced by the Secretary of State and with regard to the overall level of capital funds available. Icknield school submitted a bid for the second type of funding.
It is always a disappointment for a school when it has a capital project turned down. Sadly, such disappointments are inevitable when demand always outstrips supply and hard choices must realistically be made. That is not only true for self-governing schools but a fact of life across all educational sectors. Nevertheless, a substantial amount has been made available for 1994–95 which, especially in the present tight economic climate, reflects the Government's full-blooded commitment to self-governing schools. I shall say more about that in a moment.
I assure my hon. Friend and the governors, staff and parents at the school that the bid was given full and careful consideration. I understand only too well the effort that goes into preparing such bids; rejecting them is certainly not something that we do lightly. In the case of Icknield high school, we followed standard procedure in obtaining detailed advice on its bid both from Ofsted and from our

in-house team of architects before coming to a final decision. Although the bid as presented was turned down, the school has since been invited to bid for emergency funding on health and safety grounds. Officials from my Department contacted the school in January setting out the criteria for emergency grant, and we are awaiting details from the school on what needs to be done. Once the details are available, we shall of course consider the case for emergency funding as a matter of urgent priority.
I can certainly assure my hon. Friend here and now that any projects required on emergency health and safety grounds will receive full funding if the school cannot itself find funds for the work. That is true for all self-governing schools—all may apply for funding where children would otherwise be put at risk or sent home. I know that my hon. Friend, who is assiduous in his work as a Member of Parliament, will communicate that to Icknield school as soon as possible.
Finally, in this context, it should be remembered that Icknield's bid was only one of nearly 1,000 bids received and that it was competing with all of them for a share of the available funds. In such circumstances, there will always be some schools which miss out, even though their bids are for thoroughly worthwhile projects. That, as I have said, is an unfortunate fact of life where a large number of schools chase a limited resource.
I think it is instructive, however, to take a step back at this point and look at the full scope of capital funding available for self-governing schools. In December, the Government announced a package of more than £150 million for capital work at self-governing schools. As a consequence, two thirds of schools new to the sector stand to gain support for large-scale capital projects. As we have made clear many times, it is vital that schools entering the sector are established on a sound footing, and the latest package underlines our commitment to that goal.
Of the £150 million, £37 million will be provided to enable new and existing schools to begin work on major projects in the next financial year. In addition, funding had been set aside for projects for new schools entering the sector between September 1993 and January 1994. Announcements will be made about that next month, and the new work will build on the substantial capital work that has already been carried out in self-governing schools over recent years.
Almost £28 million is being provided in 1994–95 for continuing work in schools on projects started last year. That means that next year major capital work will be taking place in around half of all the self-governing schools which were operating by September 1993.
In addition, more than £30 million worth of projects in 82 schools have been identified as high priorities for funding in 1995–96. They will all receive funds in 1994–95 to start development work on the projects. Even that is not the end of the story, however. As well as allocations for major capital projects, self-governing schools receive a formula capital allocation. Thirty million pounds has been set aside for capital formulae in 1994–95. It is available to all self-governing schools and will be at an enhanced rate over last year, including a £16,000 minimum level which will be of particular benefit to smaller primary schools.

Mr. Carlisle: May I express the gratitude of Icknield high school for the increased capital funding that it receives? To save time, may I again ask my hon. Friend to consider whether, when he examines capital funds and the


reports that he receives, a school should be physically visited and inspected by members of his Department and of Ofsted so that officials might acquaint themselves with the condition of the buildings in question? In some circumstances, a written submission may not be sufficient to give a clear picture.

Mr. Squire: I had carefully noted my hon. Friend's point the first time and I must now note it doubly carefully. Perhaps he will allow me to come back to him, but I can say now that, where there was any doubt, a physical visit would certainly be made as a follow-up. However, I should like to pursue that issue some other time and get back to him later, as he would expect.
I was talking about formula capital allocation. I know from my personal experience, from visiting schools and speaking to many teachers and governors, that schools

enjoy the flexibility provided by formula allocations. It is entirely up to them to determine their priorities for the funding and I am sure that they will continue to use it productively.
Although in particular instances we cannot provide schools with all that they would wish for, the funding that we are making available for capital work will help self-governing schools to thrive for the benefit of their current and future pupils and the local communities that they serve. I am sure that my hon. Friend will appreciate the constraints under which we have to work and will continue his support of the growth of the self-governing sector, something that he made clear. It is already clear that the self-governing sector will be the model for all maintained schools in the 21st century.

Question put and agreed to.

Adjourned accordingly at one minute to Three o'clock.